Governing Body 10:00 – 12:00 Bede’s World, Church …...2015/02/17 · Welcome and introductions 2014/056 Apologies for absence Dr Matthew Walmsley 2014/057 Declarations of interest

NHS Public

Governing Body

Thursday 17 July 2014 10:00 – 12:00

Bede’s World, Church Bank, Jarrow, NE32 3DY

ITEM TIME TITLE LEAD

2014/055

10:00

Welcome and introductions

Dr Matthew Walmsley 2014/056 Apologies for absence

2014/057 Declarations of interest

2014/058 10:05

Minutes from the last meetings 15 May 2014 and 28 May 2014 Dr Matthew Walmsley

Enclosure 01 Enclosure 02 2014/059 Matters arising from the minutes

2014/060 10:10

Question time Members of the public may raise issues of general interest that relate to items on the agenda. The Chair’s discretion is final on the matters discussed and timescale.

2014/061 10:15 Chief Officer’s Information Dr David Hambleton

Quality

2014/062 10:20 Key assurances and risks from the Quality Patient Safety and Risk Committee

Mrs Ann Fox Enclosure 03

2014/063 10:30 Safety, transparency and openness in the NHS

Mrs Ann Fox Enclosure 04

Finance

2014/064 10:40 Finance report Ms Kate Hudson Enclosure 05

Performance

2014/065 10:50 Performance report Mr Aaron Tucker Enclosure 06

Commissioning Business

2014/066 11:00 2014/15 Planning update Mr Aaron Tucker Enclosure 07

ITEM TIME TITLE LEAD

Partnership

2014/067 11:10 Public Health and Health and Wellbeing update

Ms Amanda Healy Enclosure 08

Governance

2014/068 11:20 CCG Assurance – Quarter 4 (Q4)/end of year

Mr Aaron Tucker Enclosure 09

2014/069 11:30

Terms of Reference approval - Audit and Risk Committee - Quality and Patient Safety

Committee

Mrs Liane Cotterill Enclosure 10 Enclosure 11

2014/070 11:40 Annual Report Dr Matthew Walmsley Enclosure 12

Items for information

2014/071 11:50

Executive Committee minutes 1 May 2014

Dr Matthew Walmsley Enclosure 13

Executive Committee minutes 12 June 2014


Council of Practices minutes 20 March 2014


Council of Practices draft minutes 19 June 2014


2014/072 11:55 Any other business

2014/073 12:00 Question time Members of the public may raise issues of general interest that relate to items already discussed.

2014/074

Date and time of next meeting Thursday 18 September 2014, 10:00 – 12:00 Bede’s World, Church Bank, Jarrow, NE32 3DY

South Tyneside Clinical Commissioning Group Governing Body Agenda – 17 July 2014 Page 2

Agenda item 2014/058 Enclosure 01

South Tyneside CCG Governing Body

Thursday 15 May 2014 10:00 - 12:00

Bede's World, Church Bank, Jarrow, NE32 3DY

Present: Dr Matthew Walmsley Chair, South Tyneside Clinical Commissioning Group (STCCG) Dr David Hambleton Chief Officer, STCCG Mr Stephen Clark Deputy Chair and Lay Member, STCCG Mr Paul Morgan Lay Member (Governance), STCCG Mr Jeff Gosling Lay Member (Patient and Public Involvement),

STCCG Ms Kate Hudson Chief Finance Officer, STCCG Mrs Christine Briggs Director of Operations, STCCG Mrs Ann Fox Director of Nursing, Quality and Safety, STCCG Dr Tarquin Cross Secondary Care Consultant, STCCG Dr Vis-Nathan Elected GP Member, STCCG In Attendance: Dr James Gordon Clinical Director, Mental Health and Learning Disability, STCCG Mrs Liane Cotterill Senior Governance Manager, North of England Commissioning Support Unit (NECS) Mrs Laura Witters Governance Officer and minute taker, NECS 2014/026 Welcome and Introductions The Chair welcomed those present to the South Tyneside Clinical Commissioning Group (CCG) Governing Body meeting. 2014/027 Apologies for Absence

Apologies for absence were received from Mrs Helen Watson, Corporate Director of Children, Adults and Families South Tyneside Council and Ms Amanda Healy, Director of Public Health, South Tyneside Council.

2014/028 Declarations of Interest No declarations of interest were made.

2014/029 Minutes from the last meeting - 20 March 2014

The minutes of the meeting held on 20 March 2014 were accepted as an accurate record, pending the following amendments: 2014/008 – Quality, Patient Safety and Risk Committee Highlight Report • The Director of Nursing, Quality and Safety noted that on page 3,

the third bullet point should read that trajectories had been increased in line with national benchmarking.

• It was advised that the minutes should state that the risk in relation

to business continuity for the management of serious incidents and complaints had been removed from the risk register as robust systems were in place.

2014/009 – Francis Action Plan • The Director of Nursing, Quality and Safety stated that within the

first paragraph the minutes should read that the action plan had been further developed following the publication of ‘Hard Truths’.

• Within the third paragraph the minutes should reflect that the priority

was to work collaboratively with providers. • It was noted that the fourth paragraph should reflect that complaints

were reviewed in detail at the Quality Review Group and that trends and learning were presented to the QPSR Committee.

2014/011 – 2014/15 Draft Budgets • The Chief Finance Officer advised that the minutes should reflect

that funding for final budgets was assured, but the application would change for the next iteration of the budgets.

• The Chief Finance Officer noted that the NHS Property Services

billing should be £1.1m and not £1.6m. 2014/030 Matters arising from the minutes

The Chief Finance Officer noted that a revised version of the budget proposal should have been presented at the meeting; however this would now be presented at the extraordinary meeting on 28 May 2014.

2014/031 Question time

Members of the public present were asked for any questions. No questions were raised.

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2014/032 Chief Officer's Information

The Chief Officer informed those present that it was mental health awareness week and that it was appropriate that there were two substantial items later in the agenda on mental health that reflected the focus that was maintained by the CCG on mental health. Members were advised a number of events regarding mental health had taken place and were well attended, it was to be noted that it was clear that there was a passion at the events from both the service users, carers and the professionals involved. Those present were advised that work was underway on the five year plan, which was not only for the CCG, but for the whole borough. It was to be noted that the latest version of the plan was to be presented later in the day to the Local Area Team (LAT) and NHS England regional team as part of assurance of plans. The Chief Officer announced that Simon Stephens, Chief Executive of NHS England had made an announcement in relation to Co-commissioning of primary care and that the deadline for expressions of interest was 20 June 2014. Those present were notified that members from the Governing Body and Executive Team were to be involved in the discussions. The Chief Officer’s final point highlighted the Governing Body development session that had taken place to reflect on how the Governing Body worked. The review that was undertaken was covered in the Annual Governance Statement (AGS) that was presented at last meeting, the review included suggestions on how meetings were to be conducted over next 12 months.

2014/033 Key assurances and risks from the Quality, Patient Safety and

Risk Committee

The Director of Nursing, Quality and Safety informed members that the purpose of the report was to provide high-level assurance on the quality of commissioned services as a result of the work undertaken by the Quality, Patient Safety and Risk Committee. The key points of note were: • South Tyneside NHS Foundation Trust (STFT) were an outlier in

mortality reporting on the national instruments used, it had been identified following work in 2013/14 that this was due to figures from patients within St. Benedict’s Hospice. The Director of Nursing, Quality and Safety confirmed that this would remain under review as there was a potential risk, but that she felt confident of the controls and monitoring in place, which were also discussed at the regional quality group.

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• Serious incidents were being managed effectively and all providers were now part of the open and honest care project which ensured publication of harms and the lessons learnt. It was to be noted that the highest harms reported related to pressure ulcers and falls.

• Further work was progressing in relation to Continuing Health Care (CHC) and care in care homes. Those present were informed that there was a robust procedure in place with the LA, however there was room for further improvement based on learning across the North East and nationally regarding the tools used for quality monitoring in care homes and that they needed more of a clinical focus rather than contractual. It was to be noted that work was progressing with NECS and the LA to add the clinical element to processes and as a result of collaborative working significant improvements had been seen in one of the providers where there were concerns.

• The Director of Nursing, Quality and Safety highlighted there were still some safeguarding risks, but work with key partners was ongoing to manage and mitigate the risks.

The Lay Member (Governance) raised a query on the monitoring in care homes and asked when the process would be developed to provide full assurance. The Director of Nursing, Quality and Safety responded that mechanisms were in place and in terms of risk assessment the CCG quality team and NECS were working with LA, but that we were not alone as a CCG in regard to this issue. The Lay Member (Governance) also queried the issues in relation the designated doctor/nurse function for Looked after Children (LAC). The Director of Nursing, Quality and Safety advised that there were further developments underway in relations to the specifications for LAC and that it was not the case that there was no service present, but that the service needed review and enhancement. In relation to the LAC health assessments it was to be noted that the delays had been caused due to a consent issue, however members were informed that the social worker now requested the consent at the initial meeting. The Elected GP Member asked if there was training for care homes in relation to end of life care and as the Liverpool Care Pathway was to be ceased, how were end of life cases being identified. The Director of Nursing, Quality and Safety stated that there could never be enough training, part of the quality monitoring now included training needs analysis and that training is accessed through the Tyne and Wear Care Alliance and it was also noted that the CCG held a regular slot on the care home network meeting.

The Governing Body ACCEPTED the report.

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2014/034 Finance report month 12

The Chief Finance Officer provided the position of the year end 2013/14. The CCG was not able to deliver the 1% surplus, but had delivered a surplus of £617,000 (0.27%). At this stage it is was unclear if the surplus would be returned from NHS England within the following financial year. The Chief Finance Officer added that included within the appendices of the report was the split of the budgets across commissioning and running costs and noted that running costs was the area which had made the considerable contribution to underspend, in addition to a rebate from NECS which had not been expected. The Chief Finance Officer advised that it was a succinct report, as the accounts were to be reviewed by the Audit Committee on 21 May 2014, for recommendation to the extraordinary GB on 28 May 2014 for final approval. Members were informed that external audit had found no significant issues, although the only item that may be raised as part of the Value for Money (VFM) statement would be in relation to NECS controls, which had already been noted within AGS. The Lay Member (Patient and Public Involvement) wished to give thanks to the Chief Finance Officer and her team, but queried that given the pressures that had been faced, what would be in place so that they don’t re-occur during the next financial year. The Chief Finance Officer explained that plans had been put in place to mitigate pressures which included the GP improvement scheme, prescribing and CHC monitoring. It was to be noted that the real pressures had been due to external factors, for example, NHS England direction and NHS Property Service issues that have yet to be resolved. The Chair raised a question in relation to the Better Payment invoicing and those invoices that were not being paid in time and if they were reflected within the numbers. The Chief Finance Officer explained that the monitoring report excludes those invoices on hold; however she was very much aware of the issue and work was in progress with NECS and Share Business Services (SBS) to understand the gap.

The Governing Body NOTED the report. 2014/035 Performance report

The Director of Operations presented the Performance report which contained performance dashboards relating to NHS Constitution Indicators, CCG Outcome Indicators and CCG Quality Premium.

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The Director of Operations drew attention to the following key points: • Within the cancer 62 day referral pathway, there had been five

breaches. Given the concern around these breaches a root cause analysis and deep dive had been undertaken to understand why the breaches occurred.

• Patients treated within 62 days of referral by cancer screening services had seen a positive improvement in performance; however the year to date position continued to be rated red due to low numbers and breaches. The forecast for the year is that the CCG will continue to hit the target.

• Unplanned hospitalisation continued to be above trajectory and was continuing to sustain. Members were informed that work was in progress to look at practice level data and receive further clarity on the figures.

• The Friends & Family test reports measures pertaining to uptake and satisfaction scores. Uptake was slow initially and improved, however within past months is has begun to decline again. Discussions are underway with the FT to discuss the figures, development of champions within A&E and the figures are beginning to improve.

• IAPT access had been off track for most of the year; the Director of Operations noted that this would be discussed further on the agenda. Members were informed that the forecast was that the CCG would miss the target as figures remained below the 12% target and that the target for 2014/15 had been increased to 15%.

• Dementia diagnosis targets were exceeding trajectory. • Local target of referrals with patients with COPD referred into

pulmonary rehabilitation, complying with NICE guidelines, set a target of 18.7% currently achieving 28.2%.

• It was estimated that the quality premium payment would be approximately £671,000.

Discussions took place around the uptake and response on the F&F test and it was explained that the score calculation was complex and a national evaluation was underway on the way the scores were calculated. It was agreed it was a useful indicator, however it would be useful to have something more meaningful and clearer to the public. It was noted that the F&F test was monitored via the QPSR Committee. The Secondary Care Consultant stated that he shared the concern regarding the cancer referral breaches and also asked what capacity in memory services was in place following the dementia diagnosis. The Clinical Director stated the reason the CCG had seen a rise in the diagnosis had been because of the memory protection service and that he was confident that the majority of those diagnosed were receiving the right care.

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The Director of Nursing, Quality and Safety added that in relation to the cancer waiting time targets that would impact upon the quality aspect were also reported via the QPSR Committee.

The Governing Body NOTED the report. 2014/036 2014/15 Planning update

The Director of Operations provided a breakdown of the highlights of the report for those present, which included: • The final detail of the Better Care Fund plan had been submitted to

NHS England on time and members were informed there were number of trajectories identified within the report that the CCG would be measured against from 1 April 2015.

• Four key transformational schemes had been identified as vehicles to integration and achievement of outcome ambitions, which were:

o Integrated Community Teams o Self-Care o Change for Life Programme o Integrated hub

• As part of the 2014/15 national planning requirements the CCG five year plan was to be submitted by 20 June. A special session for Governing Body and Executive Committee members was to be arranged for 12 June to discuss the plan in more detail.

• The plan on a page had been developed in a different way for 2014/15 and was a more visual approach which was felt to be more powerful than previous plans.

• GP scheme focusses on four areas cancer, cardiovascular and respiratory disease and end of life care.

It was to be noted that the final sign off for the plan would be via the Executive Committee as the next meeting of the Governing Body was not until 17 July 2014.

The Governing Body ENDORSED the report.

2014/037 Psychological therapies review

The Clinical Director explained the purpose of the paper was to discuss changes to the provision of psychological therapies. He informed members that South Tyneside were one of the first sites to embrace and train to provide the new national service when it had initially been set in place. The Clinical Director noted that the service also showed signs of its legacy of being one of the first services, including issues with staff retention and long waiting times, which had led to GP reluctance to send services users into the service because of the lengthy wait. It was to be noted that there were national targets for access and recovery

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and that the service’s recovery rates were on trajectory to achieve the 50% target by April 2015, the access rates had failed to make any improvement, maintaining a figure in the region of 10%, missing their target of 12%. The Clinical Director informed members that the service had undertaken work to improve how the therapy was delivered and had achieved good results, however no improvements had been made in relation to access to the service. The Governing Body were updated that historically the service had never been a formally tendered service and that this may provide some commissioning structural issues, however it was to be noted that some third sector providers were currently being contracted to provide services in addition to the main provider. Members were advised that it was felt that the current position was no longer sustainable and there was a need to do something more fundamental and proactive. Members were asked to provide their endorsement to one of the following four options: 1. Continue to work with the present provider in developing existing

services. 2. Full tender with a single provider. 3. Full tender encouraging partnership bids. 4. Delay tendering.

The Clinical Director noted that he favoured option three, as he felt that mental health was not the sole responsibility of a single provider and should be undertaken as a health community. The Deputy Chair stated that the information provided by the Clinical Director reinforced the report significantly; however he felt that there were a lack of view from service users and patients and that these views could have been reflected upon as part of the process. The Clinical Director agreed that there was a lack of engagement, however this would be incorporated and in place going forward. The Lay Member (Governance) noted that paragraph 7.6 within the report suggested that the current provider could do no more and agreed with the Clinical Director in relation to a change in the service provider. The Secondary Care Consultant also mirrored this opinion. The Deputy Chair queried when it was expected that the contract would be in place. The Clinical Director stated that the target was for the start of the next financial year; however it was unlikely this target would be met and had been noted as a risk.

The Governing Body AGREED to move forward with OPTION 3.

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2014/038 My Life, My Mental Health Services - Proposals to transform mental health services in South Tyneside

The Clinical Director advised members that the purpose of the report was to seek a decision on how to proceed following the consultation My Life, My Mental Health Services and the large change that the proposal represented. Members were informed that the consultation focussed on two areas which were to improve services and to meet efficiency expectations. The Clinical Director stated there had been an excellent response to the consultation and that public meetings had been well attended. The main themes that were prevalent throughout the consultation were: • Travel to the proposed new site in Ryhope.

The Clinical Director advised that Northumberland, Tyne and Wear NHS Foundation Trust (NTW) were intending to include a range of solutions to include both public and private transport, which would be communicated to those requiring it. It was to be noted that these plans would be managed on an ongoing basis.

• Police interface. Members were informed that at present patients requiring assessment under Section 136 involved a resource intensive process for police and that often 136 suites were not staffed, which meant that police are not able to discharge the patient from their care until the assessment has been undertaken. Under the proposed new plans work will be embarked on to implement a street triage team, with a trained mental health nurse to decide if it is necessary to use Section 136. In addition work was underway with NTW to provide a fully staffed 136 suite and that good progress had been made.

• Ongoing carer/patient involvement and effective communications. The Clinical Director stated that good progress had been made with a number of individual families and carers associations, but it would be something that was monitored and that the CCG would continue to participate in community engagement work.

Members were asked to provide their endorsement to one of the following three options: 1. Halt the process and keep the current model. 2. Commit to the programme based on available evidence. 3. Grant authority to progress a phased implementation programme.

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The Clinical Director noted that he favoured option three. The Deputy Chair noted his appreciation for the Clinical Director’s contribution to the work undertaken and advised that it would be necessary to keep an oversight of the consultation plan as it progressed. The Director of Nursing, Quality and Safety advised members that there would be a robust monitoring via the Northumberland, Tyne and Wear Quality Review Group and also the Contract Monitoring Review Group which was currently being established. The Lay Member (Patient and Public Involvement) agreed with the preferred option and noted the commitment given by the Clinical Director. The CCG Chair advised those present that the Chief Officer would hold responsibility for progress monitoring and to oversee implementation and updates would be provided to the Governing Body at the Chief Officer’s discretion. The Governing Body expressed their thanks to the NECS Communications Team for their work on the consultation.

The Governing Body AGREED to move forward with OPTION 3. 2014/039 Public Health and Health and Wellbeing update

Members agreed that this item would be deferred to the next meeting, having received apologies from the Director of Public Health who was unable to attend this meeting.

2014/040 CCG Assurance - Quarter 3 (Q3)

The report presented to the Governing Body set out the final position in relation to the Q3 Assurance process, which had been assessed by NHS England. The Director of Operations drew attention to the letter from NHS England which set out a very good outcome in relation to the performance of the CCG. The Director of Operations informed members that the Quarter 4 review would be available at the next meeting of the Governing Body.

The Governing Body NOTED the report.

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2014/041 Risk management review

The Director of Operations presented the latest risk management report and provided an overview of the current status. The current high risks related to the areas of secondary care overspend and quality and safeguarding. Members were advised that work had been undertaken within the last week to review the safeguarding risks that would not be reflected until the next update report. The Deputy Chair questioned the use of ‘catastrophic’ as it would be rare for a catastrophic event to take place and the Director of Operations informed him that further training was scheduled for June and August to ensure a standardised way of input and review of risks. The Lay Member (Governance) queried why the residual score on risk 226 was higher than the initial score. The Chief Finance Officer explained that there was little mitigation that could be applied, which is why the score increased. The Secondary Care Consultant queried the targets for health care acquired infections (HCAI). The Director of Nursing, Quality and Safety advised that there was still a 0% tolerance in relation to MRSA, however the targets for C. Difficile had changed and these were regularly monitored via the regional HCAI review group and significant improvements were being made.

The Governing Body ACCEPTED the report. 2014/042 Policies for approval

The Director of Operations presented the Complaints Policy to members for discussion. Discussions took place in regard to who decided and how an expression of concern became a complaint. The Senior Governance Manager advised that this was decided on a case by case basis and discussion would take place with the complainant before taking forward. It was generally felt there should be a personalised statement within the introduction to the policy and the Director of Nursing, Quality and Safety indicated that recommendations from the Clwyd-Hart review into how complaints were handled by NHS hospitals should be included within the policy for completeness.

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Members agreed to adopt the restyle of the document, however it was agreed that further work would be required to the body of the document and that oversight for final approval would be undertaken by the Quality, Patient Safety and Risk Committee.

The Governing Body DEFERRED the policy until further amendments were made.

2014/043 Items for information

The minutes of the Executive Committee meetings held on the 13 March 2014 and 10 April 2014 were accepted. The minutes of the Council of Practice meeting were accepted; however members suggested that it would be useful for the attendance lists from the Council of Practices to be added as an appendix to show the attendees.

2014/044 Any other business

There were no items under any other business. 2014/045 Question time

Members of the public present were asked for any questions. No questions were raised.

2014/046 Date and time of next meeting

An extraordinary meeting of the Governing Body is to take place on Wednesday 28 May 2014, 13:30 - 15:00, in Meeting Room 1, South Tyneside Clinical Commissioning Group. The next meeting of the Governing Body will be held on Thursday 17 July 2014, 10:00 - 12:00, at Bede's World, Church Bank, Jarrow, NE32 3DY.

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South Tyneside Clinical Commissioning Group Governing Body

Extraordinary

Wednesday 28 May 2014 14:00 - 15:30

Meeting Room 1, Monkton Hall

Present: Dr Matthew Walmsley Chair, South Tyneside Clinical Commissioning Group (STCCG) Dr David Hambleton Chief Officer, STCCG Mr Stephen Clark Deputy Chair and Lay Member, STCCG Mr Paul Morgan Lay Member (Governance), STCCG Mr Jeff Gosling Lay Member (Patient and Public Involvement),

STCCG Ms Kate Hudson Chief Finance Officer, STCCG Mrs Ann Fox Director of Nursing, Quality and Safety, STCCG Dr Vis-Nathan Elected GP Member, STCCG In Attendance: Mr Cameron Waddell Director and Engagement Lead, Mazars Mr Martin Barnes Engagement Senior Manager, Mazars Mrs Liane Cotterill Senior Governance Manager, North of England Commissioning Support Unit (NECS) Mrs Laura Witters Governance Officer and minute taker, NECS 2014/047 Welcome and Introductions

The Chair welcomed those present to the South Tyneside Clinical Commissioning Group (CCG) extraordinary Governing Body meeting. The Chair advised that due to the tight deadlines for submission of the annual accounts and annual report it had not been possible to hold this special meeting at a public venue, however the minutes of this meeting would be made available to the public at the next Governing Body for ratification.

2014/048 Apologies for Absence

Apologies for absence were received from Dr Tarquin Cross, Secondary Care Consultant, Mrs Christine Briggs, Director of Operations, Mrs Helen Watson, Corporate Director of Children, Adults and Families South Tyneside Council and Ms Amanda Healy, Director of Public Health, South Tyneside Council.

2014/049 Declarations of Interest

Declarations were made by the Chair and Elected GP Member in relation to the budgets on GP expenditure.

The Chief Finance Officer added that he Governing Body members were required to make the following disclosure to the auditors;

Each member present confirmed that as far as he/she was aware there was no relevant audit information of which the clinical commissioning group’s auditors are unaware. In addition, that he/she has taken all the steps that he/she ought to have taken as a member of the Membership Body/Governing Body in order to make himself aware of any relevant audit information and to establish that the clinical commissioning group’s auditors are aware of that information (Companies Act 2006 Section 418 requirement adopted by the Government Financial reporting Manual. Note: paragraphs 418(5) and 418(6) are not applicable).

It was agreed that members who were not present could make their disclosure via e-mail following the meeting.

2014/050 Revised budget

The Chief Finance Officer informed those present that the budget had been presented at the meeting in March; however further amendments had been required. The Chief Finance Officer stated that the main change to the budget had been a request from NHS England to include the surplus in position and that there had been £513,000 added back into the budget and placed in reserves until further clarity was received on where it would be spent.

The Governing Body APPROVED the revised budget.

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2014/051 Annual Accounts

The Chief Finance Officer apologised to members for the piecemeal distribution of papers prior to the meeting and advised that the annual accounts, annual report and draft letter of representation had been presented to the Audit Committee who had provided the recommendation for approval by the Governing Body at this meeting. The Director and Engagement Lead informed those present that further guidance had been released in relation to the Continuing Health Care (CHC) position, which had not been included within the accounts and for which no provision had been made, had been released on 27 May 2014. Members were advised that there would need to be an amendment made to the accounting policies and notes in relation to CHC and to date external auditors had received no figures from NHS England and that there had been an expectation by NHS England that the CCG would be indicating what the figure would be. The Chief Officer queried if other CCGs were in the same position. The Director and Engagement Lead confirmed that they were and that it would be easily altered, as there would be no amendment to the ledger. Members present voiced some concern about the guidance provided, however it was agreed that the CCG would follow the instructions set by NHS England. The Director and Engagement Lead circulated an audit completion report to members present and drew attention to the following key points: • Everything was noted to be on track for completion of the audit and

there had been nothing to report in relation to the remuneration report or the annual report.

• The Value for Money conclusion is typically a yes/no response, however it was to be noted that the criteria had not been applied for year one. The Director and Engagement Lead noted that the only risk highlighted had been the lack of assurance from NECS for the period up to 30 September 2013.

• Following the Audit Committee that had been held on the 21 May 2014, additional areas had now been audited and for those areas outstanding the delay had been due to receipt of answers to specific queries.

• In relation to significant findings, anything material had been tested, including prescribing and there were no findings to report. It was noted that testing had been at a substantially lower level and more work had been undertaken that usual in year one.

• The Director and Engagement Lead noted the suggested amendments on page nine of the report and recommended that they be included within the management representation letter, contained in Appendix A of the report, which would be signed by the Chief Officer.

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The Elected GP Member questioned GP payments from the CCG, Local Area Team (LAT) and Public Health and if there were discrepancies, if it would show in the accounts. The Chief Finance Officer informed members that if it were the payments from the CCG it would show as an accrual in the accounts. The Director and Engagement Lead added that the LAT were audited by the National Audit Officer and would appear in the accounts for NHS England. The Lay Member (Governance) queried if it would be appropriate to hold a session to reflect on the processes this year and see what could be improved upon for the upcoming year. The Director and Engagement Lead noted that some of the issues that occurred weren’t likely to reoccur in the next year as the CCG and NECS would no longer be new organisations. The Chief Officer queried how the materiality figure was determined. The Director and Engagement Lead stated that for all CCGs materiality was a percentage of the operating costs and that this year it had been set at 1%. In relation to performance materiality the percentage was between 55% and 75% and that everything in the accounts above that number had been tested. The Director and Engagement Lead noted that if a figure was below the triviality threshold of £69k that it would not be reported on.

The Governing Body APPROVED the annual accounts subject to the amendments discussed.

2014/052 Annual Report

The Chief Officer advised members that the annual report had not been presented to the Governing Body before this meeting; however members of the Audit Committee had seen a draft of the document previously. The Chief Officer stated that the following amendments had been made since it had been presented to the Audit Committee. • There was a reduced internal audit opinion within the remuneration

report. • The Risk Framework had been expanded. • An expansion on control mechanisms had been added. • Typographical errors had been rectified.

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The Director of Nursing, Quality and Safety requested the following additional amendments. • On page 26 it was noted that the Governing Body membership

listed the Head of Quality and Safety as ‘in attendance’ and it was recommended this was removed, as the Head of Quality and Safety had been attending until the appointment of the Director of Nursing, Quality and Safety.

• It was noted that the profile for the Director of Nursing, Quality and Safety was missing from page 40.

• The Director of Nursing, Quality and Safety requested a footnote be added to the attendance record table on page 47, as she had not started in post until May 2013 and had not been able to attend any earlier meetings.


There were no items under any other business. 2014/054 Date and time of next meeting

The next meeting of the Governing Body will be held on Thursday 17 July 2014, 10:00 - 12:00, at Bede's World, Church Bank, Jarrow, NE32 3DY.

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REPORT CLASSIFICATION – please refer to Report Classification Guidance and check appropriate box below

NHS Confidential NHS Protect Public

MEETING TITLE: Governing Body DATE: 17 July 2014

REPORT TITLE: Report from the Quality, Patient Safety and Risk Committee

AGENDA ITEM: 2014/062 ENCLOSURE: 03

LEAD DIRECTOR / REPORT SPONSOR:

Name/Title: Ann Fox, Director of Nursing, Quality and Safety South Tyneside Clinical Commissioning Group Tel/E-mail: 0191 512 8473 [email protected]

REPORT AUTHOR: Name/Title: Amanda McEwan, Clinical Quality Manager, North of England Commissioning Support Unit (NECS) Tel/E-mail: 0191 374 4221 [email protected]

REPORT SUMMARY / RECOMMENDATIONS:

Purpose of report The purpose of this paper is to provide South Tyneside Clinical Commissioning Group (STCCG) Governing Body with high-level assurance on the quality of commissioned services as a result of the work undertaken by the Quality, Patient Safety and Risk Committee (QPS&R) within its terms of reference. Key issues, assurances and risks The paper provides assurance that the appropriate actions are being taken forward to ensure that any risks to patients are being managed accordingly. Appendix A contains the approved minutes of the meeting of the formal QPS&R held on 16.04.14. The key assurances and controls in place to mitigate risks are identified below. Key Issues • Serious Incidents (SI) • Quality of care in South Tyneside Care Homes • Continuing health Care (CHC) • Safeguarding Adults and Children Key assurance The Serious incidents (SI) • The panel continues to monitor and review the SIs that are reported

and are working in collaboration with the providers of services for STCCG residents, South Tyneside Foundation Trust (STFT), City Hospital Sunderland Foundation Trust (CHSFT), Northumberland and Tyne and Wear Foundation Trust (NTWFT) and North East Ambulance Foundation Trust (NEAS). As a result significant assurance has been given that this is no longer deemed to be classified as a risk to the CCG.

South Tyneside Care homes • All care homes received a monitoring visit during 2013/14 by South

Tyneside Council (STC). In addition to the planned (announced) visits, they are also conducting a series of unannounced visits, in order to monitor improvements against action plans where indicated.

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This process offers assurance in terms of ‘point of time’ quality of care. The process of linking soft intelligence shared at South Tyneside Information Sharing meeting, and subsequent actions taken is ongoing. This process is used to inform the unannounced visits to care homes, and occasionally may also prompt an inspection visit been brought forward by CQC. This is linked to actions identified in the STCCG Quality Action Plan, which now includes national publications on quality and safety such as the Winterbourne View, Berwick and Clywd and Hart.

Health Care Associated Infections (HCAI) • STFT were over trajectory targets for both MRSA and C. Diff rates at

the end of March 2014. Weekly sharing of data between STFT and STCCG is in place and assurance has been given that controls are in place. Comprehensive action plans are in place to tackle these issues, which are monitored by the HCAI improvement group and assurance has been given that controls are in place.

CHC • Decisions which are taking longer than 28 days are now monitored

and managed via contract monitoring. A CHC business meeting had been established and checklists are monitored through that meeting.

• In terms of avoiding delays in putting services in place and delivery of care through the fast track process, this is now a more robust process after an audit has taken place. The high cost for End of Life Care is now been managed and a process of e-mail authorisation is in place, with the authorisation then going to panel to fully consider recommendations and either accept or amend and forward to the CCG for formal ratification.

Safeguarding Adults and children • Work continues around the development of the Looked After Children

specification. The Designated Doctor for Safeguarding at STFT has agreed to provide the strategic Doctor role. The Multi Agency Looked After Partnership Board (MALAP) has revised its terms of reference and governance arrangements.

• Further work continues with contract managers to ensure safeguarding work is measurable within contracts.

• The induction and regular meetings have taken place with the Named GP for Safeguarding Children. The role of Named GP for safeguarding adults has been advertised within South Tyneside again.

• There continues to be concerns within a Care Home (Four Seasons is the provider) to address these regular meeting to monitor the improvement action plan are taking place.

• Money has been allocated by NHS England to each CCG for the purpose of ensuring the Mental Capacity Act (MCA) and Deprivation of Liberty (DOLs) knowledge, training and support is robust within health services. A steering group was set up with Sunderland CCG and relevant Local Authorities, MCA leads to develop a programme of work to ensure the money could be used appropriately and effectively.

• A Serious Case Review (SCR) into the serious harm of a young child whilst in the care of relatives has been revised and the final draft was considered at the Safeguarding Children’s Board (SCB) on the 1.5.14. A media strategy and plan for publication was agreed at this time.

• A SCR is underway into the circumstances of a young man found to be severely neglected. The terms of reference are agreed and the identified agency reports were to be submitted to the SCB on the 28.4.14. The CCG is presently completing the GP report which is being written by the Named GP, with oversight from the Head of Safeguarding. The Area team will be asked to sign off the report once


completed. A session was planned for dissemination of the learning in early June to all partners.

Key Risks • The quality of care within care homes; with one particular care

highlighted as raising concerns. • The role of Named GP for Safeguarding Adults remains vacant. • CHC, adherence to the CHC National framework. Appendix B contains the approved minutes of the informal meeting held on 25.05.14. The Head of Safeguarding provided a summary of the session which included an overview of safeguarding children, the CCG responsibilities, the local safeguarding picture and inspections. Recommendation/Action Required All of the above identified risks are on the risk register and have controls and assurances in place to mitigate the risks. The Governing Body is asked to note the contents of the report and receive it as assurance that the Quality Patient Safety and Risk Committee is discharging its responsibilities in line with the Terms of Reference.

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Quality, Patient Safety and Risk Committee Formal

Wednesday 16 April 2014

13:30 – 16:30

Meeting Room 1, Monkton Hall Present: Mr Stephen Clark Lay Member (Chair), South Tyneside Clinical

Commissioning Group (STCCG) Mr Jeff Gosling Lay Member, STCCG Mrs Ann Fox Director of Nursing, Quality and Safety, STCCG Dr David Hambleton Chief Officer, STCCG In Attendance: Ms Helen Smith Operations and Engagement Manager, STCCG Mrs Carol Drummond Head of Safeguarding, STCCG Mrs Jeanette Scott-Thomas Head of Quality and Patient Safety, STCCG Mrs Amanda McEwan Clinical Quality Manager, North of England

Commissioning Support Unit (NECS) Mr Dave Jopling Quality and Regulated Services Commissioner,

South Tyneside Council Mrs Liane Cotterill Senior Governance Manager, NECS Mrs Laura Witters Governance Officer and minute taker, NECS Mrs Victoria Dunn Patient Apologies: Dr Matthew Walmsley CCG Chair, STCCG Dr Vis-Nathan GP Governing Body member, STCCG Dr Tarquin Cross Secondary Care Consultant, STCCG 2014/21 Welcome and Introductions

The Chair welcomed members to the meeting and a round of introductions took place.

Appendix A

Ratified: 18 June 2014

2014/22 Patient/carer story

Victoria is pregnant with her second child which is due in August 14. Victoria’s first child was born in 2010.

Summary of Experience

In 2010 when Victoria was pregnant with her first child there was no consistency with the midwife. Victoria was told that Anne would be her midwife but she only met her twice. Victoria was registered with Marsden Road Health Centre at that time. As this was Victoria’s first child she didn’t know what to expect. The midwives she did see did not pick up Victoria’s mental health issues and gestational diabetes. Victoria feels that if she had just one midwife it would have improved care.

Since her first pregnancy Victoria has moved house so is now registered with The Glen Medical Group in Hebburn. In her current pregnancy Victoria sees only one midwife, Sue Hardy. Sue has been very supportive and gone over and above her remit to contact Victoria to check on her and ask if she can support her in any way. Victoria is currently 22 weeks pregnant and has been seeing Sue since being six weeks pregnant. During December 2013 Victoria was sent for an early scan as it was thought there was a risk of miscarriage; Sue sorted this out and made sure Victoria had the scan. Victoria was going through difficult personal circumstances and Sue supported her and gave her advice and information. Sue also helped to organise counselling for Victoria. Victoria was referred to Angela Lorraine at Monkton Hall who has been excellent. Victoria is still seeing Angela and feels she is very supportive. Victoria feels that it is obvious that Sue has read her notes as she asked Victoria about her mental state. Sue is very intuitive and picked up on issues and realised that Victoria needed counselling.

In 2010 Victoria had a very poor experience of labour at STFT; she had an emergency section which then wouldn’t heal. After the birth Victoria had traumatic stress and had counselling on this occasion also. Sue picked up on Victoria’s anxiety around STFT and ensured that she was referred to the RVI. The RVI is excellent – Victoria feels very well looked after and all the staff are very efficient. Staff at the RVI have also looked closely at Victoria’s notes and have advised a planned section. Victoria is happy about this and it has relieved her anxiety.

Main Weaknesses

2010

• Inconsistency with midwives who didn’t know Victoria • Hospital delivery was a negative experience

o On the night of the birth there were 25 women in the maternity unit so short staffed

Ratified: 18 June 2014 Page 2 of 14

o Staff didn’t check for DVT, although Victoria had a history of this, and she wasn’t given support stockings

o Victoria wasn’t washed until five hours after the operation o Staff told Victoria she was over emotional and should pull

herself together o Staff took 45 minutes to respond to Victoria pressing her

buzzer when her baby was in distress

Main Strengths

2013/2014 • The midwife is clearly very experienced and exceptional at her

job • The midwife uses her own initiative to go above and beyond her

remit because she cares • The midwife’s quick reactions to how Victoria is feeling

Victoria made a formal complaint to Lorraine Lambert regarding her 2010 delivery so information about 2010 is to put her present day story into context. Victoria has been updated that changes have been made at STFT but she still didn’t have confidence in the system. Victoria wanted to share her positive experience and give praise to staff on this occasion. Questions and discussions took place throughout the story and the following key points were identified:

• The Head of Quality and Patient Safety stated she would have expended that STFT would have had a contingency plan in place to deal with a large number of birth in one evening.

• The Chief Officer noted that Victoria experience two very different experiences and this should not depend on what the midwife can do.

• The Chief Officer advised that maternity services were something people were interested in and that in the future there may be a view to look at centralising services and asked Victoria if she would be interested in coming back to discuss at a point in the future.

• The Chief Officer noted that STFT had invested in their maternity ward, however it still did not feel up to the standard of City Hospitals Sunderland NHS Foundation Trust (CHS) and the Royal Victoria Infirmary and that having feedback from patient and carer experience was the key thing.

The Chair thanked Victoria for attending the Committee and sharing her experiences.

Victoria left the meeting following this item.


2014/23 Previous story update and feedback The Operations and Engagement Manager updated the Committee in relation to last story presented at the meeting on 19 February 2014 and circulated a response received from Northumberland, Tyne and Wear NHS Foundation Trust (NTW). The Chief Officer noted that it was important that the Trust had acknowledged the two year wait and had offered their apology.

The Operations and Engagement Manager left the meeting following this item. 2014/24 Apologies for absence

A number of apologies were received and are noted above. 2014/25 Declarations of interest

There were no interests declared. 2014/26 Items for any other business

There were no items of other business. 2014/27 Minutes of the last meeting – 19 February 2014

The minutes of the meeting held on 19 February 2014 were held as a true record.

2014/28 Matters arising and review of action log

There were no matters arising from the minutes.

The following actions on the log were reviewed:

2013/36 – It was agreed that this could be closed, as it was a national matter. 2013/78 – It was noted that there was now a process in place which could be influenced. It was agreed that the updated visit schedule would be circulated with the draft minutes of the meeting and that the item could be closed. Action: Governance Officer to circulate the visit schedule Nov 2013 – LAT invitation to join Committee. It was agreed that this item needed to be formally picked up. The Director of Nursing, Quality and Safety stated she would take this forward and contact Moira Angel.


Action: The Director of Nursing, Quality and Safety to contact Moira Angel

2013/97 – The Director of Nursing, Quality and Safety advised that this had been completed and the item could be closed. Jan 2014 – The Governance Officer advised that all informal sessions were confirmed and the item could be closed. 2014/07 – The Director of Nursing, Quality and Safety advised that this could be closed, as there had been significant progress relating to CHC processes. 2014/07 – The Governance Officer advised she had re-ordered the action log and the item could be closed. 2014/08 – The Clinical Quality Manager advised that this item was on the agenda and could be closed. 2014/08 – The Director of Nursing, Quality and Safety advised she had discussed the matter with Healthwatch and that they have clear criteria in place and were in the process of training people to undertake the visits. It was to be noted there was a meeting to take place week commencing 21 April 2014 and that feedback would be provided at the next formal meeting in June. 2014/08 – The Clinical Quality Manager advised that this had been looked into and the risk had been reducing and they were now on target. It was agreed that this item could be closed. 2014/11 – The Head of Quality and Patient Safety advised that this item was on the agenda and could be closed. 2014/12 – The Governance Officer advised that this item had been added to the agenda and could be closed. 2014/16 – The Senior Governance Manager informed the Committee that the policy had been part of a suite of policy documents provided to all CCGs and that revised versions, tailored to CCGs were being reviewed and written. The Director of Nursing, Quality and Safety asked for the revised policy to be forwarded to the Head of Quality and Patient Safety and the Clinical Quality Manager before it returned to the Committee for ratification. 2014/17 – The Governance Officer advised the document had been updated. It was noted that the cycle would end following this meeting and it was agreed that a draft would be presented at the next formal meeting for final approval.


2014/29 QPSR highlight report for January and February 2014

The Clinical Quality Manager presented the report to the Committee and highlighted all of the key figures for each of the providers. The following queries were raised by members in relation to: NTW • The Director of Nursing, Quality and Safety asked if a response

had been received in relation to the trend on unexpected deaths. The Clinical Quality Manager stated it had not and that she would chase up.

• It was noted that work had been undertaken in relation to restraint and that the Clinical Quality Manager would source the details for the next report.

STFT • The Chair noted that the Trust were pressing the coroner for a

verdict of accidental death, whereas the coroner was looking at negligent death as the patient may not have been dealt with in a timely manner. The Director of Nursing, Quality and Safety stated that coroner verdicts were a regular agenda item of the QRG and had asked the Trust for a review as to why it was not an SI and that the feedback was due at the next meeting.

CHS • It was observed that CHS figures had dropped and they now had

three elevated risks and six other risks. The Director of Nursing, Quality and Safety informed the Committee that CHS were challenging the report as some of the data used was out of date and that it was unlikely to see a change until the next report.

Staff Survey • The Lay Members raised a concern in relation to the issue of

figures from the staff survey, in particular those relating to staff stress and motivation. The Director of Nursing, Quality and Safety assured the Committee that this was discussed at the QRG and an action plan was in place, in addition a review of workforce reports were now seen by the QRG and STFT had acknowledged the way appraisals had been addressed and all manager were now aware they needed completion.

Discussions took place in relation to the content of the cover sheet and it was agreed that they would all include a conclusion, rather than just the basic statistics.

The Committee NOTED the report.

Action: Clinical Quality Manager to chase response from NTW in relation to unexpected deaths.


Action: Clinical Quality Manager to provide an update on restraint in next report. 2014/30 Continuing Healthcare update

The Head of Quality and Patient Safety informed the Committee that she had asked the Commissioning Manager - CHC to layout the report to highlight the key issues. The main points of note were: • Decisions taking longer than 28 days were now monitored and

managed via contract monitoring. • A CHC business meeting had been established and checklists

were monitored through that meeting. • Delivery of care through fast track was now more robust and an

audit of the processes in place had been undertaken. • The high cost for End of Life Care was now being managed and a

process of e-mail authorisation was in place, with the authorisation then going to panel for reflection.

• Some cases were not being identified in relation to S75 and assurance was being sought.

The Chair queried how many valid retrospective cases there currently were and was advised that the numbers were low out of the cases reviewed and that the figures went up due to an administrative error which had meant the team in South Tyneside had received files that had previously been closed or had missed the deadline for submission and it had not been clear in the paper files held. This resulted in people being contacted and these were now included within the figures. The Head of Safeguarding raised a concern that she had not been alerted to the safeguarding issue identified and would not be able to comment until she received further information in relation to the matter. The Committee agreed that there was more clarity as to the position of CHC and it was confirmed that processes would improve now the CHC business meeting was in place.


Action: Commissioning Manager CHC and Head of Safeguarding

to discuss the safeguarding issue identified in the report. 2014/31 Safeguarding highlight report

The Head of Safeguarding provided an update on the key points in relation to the safeguarding agenda.


• There was now a designated Dr for the Looked After Children strategic role, however there was still a vacancy for the strategic nurse role.

• Interest had been indicated in the named GP for safeguarding adults, however the Head of Safeguarding noted there was a small concern in the time that would be available from the GP who had expressed the interest.

• Job descriptions had been released, however it was unclear as to who had been consulted on the content.

• Discussions were taking place within the Local Area Team (LAT) to have named GPs, it was noted that NHS England had an overarching role in Safeguarding.

• There were currently two Serious Case Reviews (SCR) underway in relation to children and the final draft for one would be considered at the next Safeguarding Children Board (SCB), with media strategy plan to follow. The second review was still underway.

• One adult SCR was still ongoing and the conclusion was dependent on the outcome of the court case.

• There was a concern raised in relation to The Meadows and Jean Farrell would be attending a meeting regarding a carer.

• Each CCG was allocated £42k in relation to MCA and DOLS, the money is protected and sitting with the Safeguarding Board and that close work was underway with Sunderland and Gateshead on the best way to use the funding.


2014/32 Francis Inquiry

The Director of Nursing, Quality and Safety updated the Committee on the remaining two actions from the action plan which were to add in a recommendation that had been missed, which had now been completed and the other was ensure that the action plan was shared with the Governing Body, which had also been completed. Discussion took place in relation to the frequency the Committee wished to see updates on the action plan, which was to be renamed Quality Action Plan, and it was agreed that the plan would be reviewed three times a year, starting from the next formal meeting in June. Action: Governance Officer to add Quality Action Plan to the cycle

of business 2014/33 Quality Surveillance Group feedback

The Director of Nursing, Quality and Safety stated that Rule 43 letters had been discussed at both the QSG and QRG and that the CCG were reliant on other organisations to inform if a letter had been received. It was to be noted that the Care Quality Commission (CQC) received


copies of all letter and it had been agreed that they would inform the CNTW QSG and the CCG if a letter had been received locally. Other topics that were of highlight were: • Care homes - especially those homes that were owned by national

providers. It was felt that there would be more influence if NHS England supported CCGs in challenges and that this had been discussed with NHS North, however feedback was still awaited.

• Quality monitoring - a lot of work had been progressed locally on how to proactively strengthen quality monitoring and a tool had been developed but needed refreshing. It was added that a network was to be established to oversee this and ensure the clinical element and judgement was included. NEQOS had offered to develop the tool further if CCGs were to use, members were asked to be mindful that NEQOS were a commercial company.

2014/34 Quality in care homes

The Head of Quality and Patient Safety presented the report to the Committee and stated that the report covered the monitoring of contract and also the overview of where homes were currently. The Quality and Regulated Services Commissioner added that the local authority had completed 12 out of 24 unannounced visits, which last a minimum of four hours. Any recommendations from the announced visits are linked in and it was to note that they had been no major concerns. It was estimated that these visits would conclude in May. Training had been sourced in regard to mental capacity and DOLS and all 24 homes had signed up to attend. There was a long discussion around the current status of The Meadows and the key items to note were: • The CQC had given the home a warning notice and the home had,

to date, complied with the notice. • A visit was planned before the end of May to review requirement 14. • Visits occur on a weekly basis and it was found there was a lack of

consistency. • There were concerns regarding cleanliness of the building and

environment. It was noted the dining room was messy and service users were undertaking an activity in the room. In addition, a service user was noticed to have food in their wheelchair at 3pm.

• The fire brigade had been to assess the building and were due to return 10 days later to re-assess.

• The home had no stable manager since June 2013, although interviews were taking place and the council had been invited to join the interview panel.


• A member of staff had been suspended a week before this Committee meeting.

• The home does not have a link GP practice, however there were links to community nursing for patients registered with Colliery Medical Centre.

• Out of the other homes owned by Four Seasons in the borough, one was currently in the process of being sold, Chichester Court was under monitoring due to a safeguarding issue and The Lodge was found to have no major issues.

The Chair requested that the Committee was kept up to date on matters relating to The Meadows and offered support regarding any actions that needed to be taken.

2014/35 Quality Review Group minutes – February 2014

The Director of Nursing, Quality and Safety provided a summary update on the minutes of the Quality Review Group on 5 February 2014. The key points that were of note included: • Significant progress had been made in relation to the TARN audit

report and STFT had a new consultant in post. • STFT continued to be an outlier for HSMR and SHMI in relation to

mortality rates. • A high level Cost Improvement Plan (CIP) was in production and a

plan was in place to ensure review. • STFT had raised concerns in relation to the impact of providing

support to care homes. It is to be noted that work was underway with the Local Authority to address this.

2014/36 Quality in primary care

The Clinical Quality Manager informed the Committee that the primary care dashboard for the CCG was an internal dashboard developed by Jon Tose and Phil Taylor and that it was currently waiting to be progressed. The Clinical Quality Manager added that NECS co-ordinated the RAIDR system, which was not yet in a position to provide any feedback. Discussions took place on how to receive feedback on quality in primary care and the type of report that the Committee would like to see presented. It was noted that it would be useful for a meeting between the CCG, Local Area Team (LAT) and GPs to discuss a primary care strategy and what information the CCG is required to be sighted on and to explore further, as previously there has been ambiguity as to where the responsibility lies and the clarity of the CCG role and what assurance was data was needed.


The Chief Officer added that the LAT should have been providing information and that the CCG was now playing catch up. It was also noted that no CCGs were currently receiving quality reports. Action: Clinical Quality Manager to organise a meeting to discuss

a strategy for the sharing of primary care quality information.

2014/37 CQUIN

The Clinical Quality Manager presented a report on the 2013/14 achievements for the acute and community schemes for STFT. It was highlighted that there were no red indicators on the community CQUIN, only on the acute dashboard. It was to be noted that a meeting had taken place to discuss which indicators had the potential to be achieved and it was clear that they would not be able to achieve all green indicators until the evidence had been viewed. The Clinical Quality Manager followed on with the approach for CQUIN 2014/15 and stated that this would be different from the previous year, as the Trust had commented on the number of indicators. The new approach would focus on key areas to be agreed. The Committee were informed that the contracts had been signed, however the CQUIN was yet to be agreed and a meeting between Malcolm Hogan and Gary Collier was to take place to finalise this. The Chair noted that he liked the way the CQUIN targets had been addressed and the composite report that incorporated both the community and acute indicators.


2014/38 Information Governance

The Senior Governance Officer presented the CCG internal Subject Access Request procedure, which would be used in the event of a request for records received directly by the CCG or for personnel records. The Senior Governance Manager noted there were a few inaccuracies in the procedure which were: • To remove the ‘as per the Data Protection Act 1998’ from the final

paragraph on page 2 • To reword the second to last box on the flow chart on page 3. • To amend ‘FOI report’ to ‘IG report’ in the final box on the flow chart

on page 3.


• To query applying any fee levies for the record request.

The Committee agreed that following these amendments they were happy to approve the procedure.

The Committee APPROVED the procedure, pending the changes identified above.

Action: Senior Governance Officer to amend the procedure to

include the amendments identified above. 2014/39 Quality risk management report - March 2014

The Director of Nursing, Quality Safety presented the revised risk report and advised the Committee that future reports would only contain quality and safeguarding related risks. Members were advised that a review of the risks had been undertaken following the HCAI and Strategic Safeguarding meetings and these were not reflected on this version of the register, but would be on the register at the following meeting in June. The Chair queried if care homes were included on the register and it was noted that risk 445 was related to care homes. The Chair advised that the risk may need revision in light of the discussion under item 2014/34.


2014/40 Policy ratification

The following policies were presented to the Committee for approval:

• Moving and Handling Policy

The Senior Governance Manager informed members of the Committee that the policy was a document the organisation was required to have and that the content had been reviewed by Lee Crowe, Senior Governance Officer, NECS. The Chief Officer enquired if the review period for the document could be amended to every two years, the Committee agreed that this change should be applied to all policies for the CCG.

The Committee APPROVED the policy.

2014/41 Cycle of business update

The Director of Nursing, Quality and Safety presented the current cycle of business to the Committee and it was agreed noted that the cycle ended following this meeting. It was agreed that the item relating to the Annual Review of Patient Stories would be moved to the next formal


meeting and that an Annual Review of Quality Assurance should be added. The Governance Officer stated she would share the draft of the new cycle with the Director of Nursing, Quality and Safety following the meeting.

The Committee NOTED the document.

Action: Governance Officer to update cycle of business and

share draft with Director of Nursing, Quality and Safety.

2014/42 Committee Terms of Reference Review

The Director of Nursing, Quality and Safety informed the Committee that the Terms of Reference were due for review and following discussion the following key points were identified for review. • It was agreed that the membership of the Committee required

revision. • The Director of Nursing, Quality and Safety asked the Senior

Governance Manager if she could look at section 6.2 and noted it would be useful to know how other CCGs enacted this item

• It was noted that following discussion at the previous Governing Body on 20 March 2014, that risk would be moved into the remit of the Audit Committee and this section would require revision.

• It was agreed that production of an annual review of effectiveness for inclusion into the Governing Body papers would be appropriate.

• It was also agreed the document should include reference to an annual review report from sub-committees to be provided to this Committee.

The Director of Nursing, Quality and Safety stated that the revised draft of the ToR would be circulated via e-mail for comment. Action: Director of Nursing, Quality and Safety and the Senior

Governance Manager to review and prepare revised ToR. 2014/43 Minutes of sub-groups

The minutes of the following sub groups were accepted by the Committee. • HCAI Improvement Group – 22 January 2014 • Medicines Optimisation – 11 February 2014 • Informal Quality, Patient Safety and Risk Committee – 19 March

2014

The Committee NOTED the documents.



There was no other business. 2014/45 Date and time of next meeting

Informal Safeguarding Children Wednesday 15 May 2014, 13:30-16:30 Meeting Room 1, Monkton Hall

Formal Wednesday 18 June 2014, 13:30-16:30 Meeting Room 1, Monkton Hall


Quality, Patient Safety and Risk Committee Informal

Wednesday 25 May 2014

13:30 – 16:30

Meeting Room 1, Monkton Hall Present: Stephen Clark Chair, South Tyneside Clinical Commissioning Group

(STCCG) Jeff Gosling Lay Member, STCCG Tarquin Cross Secondary Care Consultant, STCCG Matthew Walmsley CCG Chair, STCCG In Attendance: Carol Drummond Head of Safeguarding, STCCG Jeanette Scott-Thomas Head of Quality and Safety, STCCG Helen Smith Operations and Engagement Manager, STCCG Amanda McEwan Clinical Quality Manager, North of England

Commissioning Support (NECS) Laura Witters Governance Officer, NECS (Minutes) Apologies: Dr Vis-Nathan GP Governing Body member, STCCG Ann Fox Director of Nursing, Quality and Safety, STCCG Welcome and Introductions The Chair welcomed members to the meeting and a round of introductions took place. Patient/Carer Story The Chair welcomed the Mr and Mrs Rye to the Committee meeting. Summary of Experience On 17 March 2014 Marjorie was crossing the road with her granddaughters and fell on her face. Marjorie’s granddaughters had difficulty helping her up so a local café owner came and helped Marjorie and brought her icepacks. Marjorie complained about pain in her neck at this time.

Appendix B

Ratified: 18 June 2014

A policeman phoned for an ambulance and was told that it would be 40 minutes to one hour before a paramedic could come to assess Marjorie. The café owner offered to take Marjorie to hospital and dropped her and her granddaughters at A&E. As Marjorie had a head injury she was taken into a cubicle in A&E straight away. Marjorie had x-rays and was then discharged three hours later. The doctor who requested the x-ray went off duty and was replaced by another doctor who looked at the x-ray and was happy that nothing was broken. Marjorie was still complaining about neck pain and was given some paracetamol and co-codeine. The next day Marjorie received a phone call from the first A&E doctor saying they had missed a fracture in her neck. A blue light ambulance was sent to pick up Marjorie. The paramedic put a neck collar on Marjorie and she was then put on a board with head blocks and taken to hospital. When Marjorie’s husband arrived Marjorie was in a cubicle with the head blocks taped to the bed; her husband was asked if she had been checked in at reception. Marjorie’s husband thought that the paramedic would have done this but hadn’t, so he checked Marjorie in with reception. There is a query about the time Marjorie is recorded as having arrived; the hospital board said 11.40am but her husband thought was nearer 10.20am. Marjorie had an MRI and CT scan and the information from these scans was faxed to the RVI. Marjorie was put on a glucose drip as she hadn’t had anything to eat, but could not go to the toilet. Marjorie lay for ten hours in the cubicle; a member of staff, who Marjorie and her husband assumed was an administrator, updated them during the ten hours saying that they were waiting for results. The manager of the ward queried why Marjorie was there for so long. The hospital arranged an ambulance for Marjorie to be transferred to the RVI at 8pm. Marjorie’s husband and daughters went to the RVI in the car, arriving at about 9pm; when they arrived Marjorie was not at the RVI and didn’t arrive until 9.40pm. The ambulance had to go from Newcastle to South Shields and then back again as Marjorie’s husband said the Shields ambulance was reluctant to take Marjorie. Marjorie was admitted to the RVI and was an inpatient for 12 days. During this time she had tests, medication, an MRI scan, a CT scan, an x-ray and was fitted with a catheter. Marjorie was very impressed by the hospital and the staff were lovely. During the x-ray Marjorie fainted so she was not discharged until the following day. Marjorie has a follow up appointment at the RVI to check her progress and for another x-ray. Marjorie visited the GP as every time she bends down she is dizzy and she is exhausted by any task. The GP said that this is normal after a trauma; the GP is going to organise a scan of Marjorie’s spine as she has a C4 fracture. Main Weaknesses

• The time the family were told it would take for an initial assessment at the accident scene

• Being discharged by the second A&E doctor • Booking in procedure – the ambulance staff should have booked in Marjorie • The time it took to transfer Marjorie from South Shields to the RVI • Lack of communication about what was happening and the time it took


Main Strengths • Paramedics who came to the house • RVI was brilliant • Staff at South Shields were nice

Suggested Improvements

• Better communication and reduce the length of time it takes to find answers to queries

• Transport between hospitals needs to be looked at Marjorie and her husband have not made a formal complaint. They told the administrator that they felt they were waiting a long time. Marjorie and her husband wanted to share their story to help improve the services. They also wanted to make the CCG aware of the details of their experience. The following comments and questions were raised during and after the story provided by Mr and Mrs Rye.

• The Head of Safeguarding asked Mrs Rye if a neck brace had been applied on admission to hospital. Mrs Rye stated she had not been given a neck brace, however on the return visit to STFT the following day her head had been strapped to a board with a collar and was not allowed to move.

• The Head of Quality and Patient Safety asked if Mrs Rye had been offered any help in relation to the flashbacks she was suffering as a result of the accident. Mrs Rye advised that she had been to see her GP, but had not been informed of the mental health services available. The CCG Chair asked the Operations and Engagement Manager to provide the contact details of the mental health service to Mrs Rye, as it was a service that she could self-refer to.

• The Secondary Care Consultant asked what tests/scans had been undertaken whilst on the board and collar. Mrs Rye stated she received further x-rays and an MRI.

• The Head of Quality and Patient Safety asked if she was provided with any pain relief. Mrs Rye advised she had been given paracetamol and co-codamol during the time spent in A&E, which didn’t help with the pain, and when she was transferred to the RVI they gave her morphine, which did help.

• The CCG Chair asked if Mrs Rye had any pressure sores as a result of the bed rest, which she stated she had not. The CCG Chair queried if Mrs Rye was given any injections to thin her blood, she responded that she did not receive an injection until her first morning in the RVI.

• The Head of Quality and Patient Safety voiced concern over the length of time that Mrs Rye was left on a trolley without food, water or the ability to use the toilet during the time in A&E.

• The Head of Quality and Patient Safety and the Operations and Engagement Manager explained that the CCG had shared the story with STFT, NEAS and NUTH, however feedback from NEAS and STFT were still outstanding. The Head of Quality and Patient Safety noted that ambulances did drive slower when carrying patients with neck injuries, which may have added to the


delays experience, but that NEAS had been asked to review the calls regarding the length of time taken for ambulances to respond.

The Chair thanked Mr and Mrs Rye for attending the Committee and they left the meeting. The Committee discussed the case further and noted there were a number of concerns relating to the treatment of Mrs Rye, which included:

• It was agreed that Mrs Rye should have been taken to hospital by ambulance following her fall and that it should not have been left to the good will of the café owner.

• It was felt that there had been a misdiagnosis by STFT, as Mrs Rye had been sent home with a C4 fracture. It was agreed that the Clinical Quality Manager would review STEIS to see if this had been raised as an SI.

• There was a need to quality control tertiary referrals. • It was agreed that Mrs Rye could have been catheterised and placed on a

drip during her time in A&E. • That STFT had not managed her pain relief properly. • There was poor communication by nursing staff to the patient and her family,

as the family had to ask what was happening. • It was felt that Mrs Rye had received poor nursing care whilst in A&E.

Action: Operations and Engagement Manager to provide contact details for

mental health services. Action: Clinical Quality Manager to review STEIS in relation to an incident

relating to Mrs Rye. Patient Stories Log The Operations and Engagement Manager tabled a document which provided the number of patients/carers who had shared their story. The paper also included the professionals and organisations involved in their care and summarised the key negative issues from the stories. In addition, it provided an overview as to whether a complaint had been by made by the patient/carer and what action had been taken to progress the intelligence from the story. The Operations and Engagement Manager stated she would ask the Governance Officer to circulate an electronic copy of the document to members following the meeting. The Chair noted the appreciation of the Committee for the responses provided by Northumberland, Tyne and Wear NHS Foundation Trust (NTW). Action: Governance Officer to circulate patient stories log to Committee

members.


Introduction to the informal session The Head of Safeguarding provided a summary of the session and that it would include an overview of safeguarding children and the CCG responsibilities, a small section on inspections and the local safeguarding picture. Safeguarding Children The Head of Safeguarding provided detail in relation to the role of safeguarding children within the CCG and the relevant underpinning legislation. Members raised the following questions and comments:

• The Clinical Quality Manager asked if the different roles within safeguarding were defined in the Children’s Act. The Head of Safeguarding informed that only the Designated Doctor and Designated Nurse roles were in the Act. It was noted that the Designated Doctor was not very visible within the CCG and that this was being looked into.

• A discussion following S11 responsibilities highlighted a weakness in the provision of safeguarding standards within contracting. The Lay Member queried if training programmes were available and it was noted that they were, however contracts were lagging behind. The CCG Chair stated that it was the responsibility of this Committee to ensure to the Governing Body that these functions were being undertaken. The Committee agreed that the emphasis of safeguarding need to be raised within contracting and that a program needed to be in place to ensure that there was appropriate time to review contracts and service specifications. The Chair asked the Head of Safeguarding to meet with NECS to discuss the next steps and report back at the next informal session, with a view to the program being added to the formal cycle of business. It was noted that if the work undertaken was pitched at the right level then it would only need to be completed once.

• The Head of Quality and Patient Safety noted that there was often a misconception that if someone is dealing with quality and safety they are also dealing with safeguarding.

Action: Head of Safeguarding to contact Gary Collier, NECS, to discuss

process to include safeguarding statements within contracts and service specifications and provide an update at next informal meeting in July.

Safeguarding Inspections The Head of Safeguarding explained to the Committee that until September 2013 safeguarding inspections had previously been joint announced inspections between CQC and Ofsted. Going forward the inspections would no longer be joint and they would look at the whole journey of the child. The last inspection in South Tyneside was in April 2013 and health received a good rating and the Local Authority (LA) received an adequate rating.


• The Lay Member asked if this was an approach that the Head of Safeguarding was comfortable with. The Head of Safeguarding explained that it was good as you received a real view of the services.

Local Safeguarding Children Board (LSCB) The Head of Safeguarding displayed a diagram of the meeting framework in relation to safeguarding and how they linked into the LSCB and how that linked in with LA Committees. It was explained that Helen Watson, Corporate Director of Children, Adults and Families was the link between the Committees.

• The Chair queried if there were still problems with membership of the Committee or if there was now continuity. The Head of Safeguarding stated that there was a good turnout for the Board and all posts were filled. The membership included a representative from the Local Area Team (LAT) and three lay members from different backgrounds.

Local Picture The Head of Safeguarding provided a breakdown of the number of children subject to Child Protection Plans and the number of Looked After Children (LAC). It was advised that the number of LAC was in addition to the number on Child Protection Plans.

• The Lay Member queried if detection was improving and the Head of Safeguarding confirmed that it was, as more people had awareness, however there was still work to be done.

• A member queried what resources were in place to support early intervention. The Committee were informed that the LA had been doing a lot of work and that services had improved.

Serious Case Reviews (SCR) The Committee were provided with a background to the regulations and purpose of an SCR and the work and costs involved with them. The Head of Safeguarding gave a breakdown of national SCRs which had been visible in the national press and informed the Committee of the two cases that were currently underway in South Tyneside. The Chair thanked the Head of Safeguarding for the presentation and the Committee agreed it important that the profile of safeguarding be raised within the CCG. The Committee concurred that feedback in relation to the action regarding contracting would be fed back at the next informal committee in relation to Safeguarding Adults and a work plan would be taken forward from that point.


Date and time of next meeting Formal Wednesday 18 June 2014, 13:30–16:30, Meeting Room 1, Monkton Hall Informal Safeguarding Adults and Quality in Care Homes Wednesday 16 July 2014, 13:30– 16:30, Meeting Room 1, Monkton Hall





REPORT TITLE: Safety, Transparency and Openness in the NHS



Name/Title: Ann Fox, Director of Nursing, Quality and Safety South Tyneside Clinical Commissioning Group Tel/E-mail: 0191 512 8473 [email protected]

REPORT AUTHOR: Name/Title: Amanda McEwan, Clinical Quality Manager, North of England Commissioning Support Unit (NECS) Tel/E-mail: 0191 374 4221 [email protected]


The purpose of this paper is to provide South Tyneside Clinical Commissioning Group (STCCG) with a summary paper of the “Safety, transparency and openness in the NHS” campaign launched in June 2014. Key issues This is a key element of the Government’s response to Sir Robert Francis QC’s Public Inquiry into Mid Staffordshire NHS Foundation Trust. There are three elements to the campaign; 1. Sign up safely 2. Hospital safety Website 3. Whistleblowing review. Key assurance Healthcare providers are being asked to the sign up safety campaign and make a public declaration of what they will do to improve safety in their organisations. CCGs are asked to encourage providers to sign up to the campaign and commit to putting safety first by publishing their safety improvement plans and reporting on progress, identifying areas of focus using national and local priorities and engaging with communities, patients and staff. The NHS Choices web site is now providing key hospital-level patient safety data in one place which means the public can see how hospitals compare in terms of safety across seven key indicators. This is to ensure that hospitals are more transparent. The website provides hospital level patient safety data in a tabular form. NHS organisations will be required to publish details of staffing levels on each of their wards every month, as well as the percentage of shifts meeting safe staffing guidelines. Key Risks STCCG will monitor the “sign up to safety” plans produced by the Trusts, and the key hospital-level patient safety results of their providers and identify any key risks that will be then discussed at the relevant Clinical quality review Groups (CQRGs). They will also monitor the safe staffing levels and discuss them with the relevant providers at the CQRGs.




Recommendation/Action Required The Governing Body is asked to note the contents of the report and seek clarification where required. Updates of the progress will be given from the Quality, Patient and safety Committee (QPS).


None


NO YES

If no please specify the reason why: This is a summary of a national document, the original EIA would have been completed on the original documentation.



For Information



Safety, transparency and openness in the NHS Introduction On the 24 June 2014 the Secretary State for Health announced a package of measures to boost safety, transparency and openness in the NHS. This is a key element of the Government’s response to Sir Robert Francis QC’s Public Inquiry into Mid Staffordshire NHS Foundation Trust. There are three elements, as follows: 1. Sign Up to Safety Campaign

Sign up to Safety aims to deliver harm free care for every patient, every time, everywhere. It champions openness and honesty and supports everyone to improve the safety of patients. This new ambition aims to reduce avoidable harm in healthcare by half, thereby saving 6,000 lives over the next 3 years. The campaign will call for everyone working in the NHS to listen to patients, carers and staff, learn from what they say when things go wrong and take action to improve patient safety.

This is in order to make the NHS the safest healthcare system in the world, building on the recommendations of the Berwick Advisory Group and as part of the journey towards ensuring patients get harm free care every time, everywhere. The campaign is aimed at generating a movement which places the safety of patients as a top priority in everything that is done. Every healthcare organisation is formally invited to sign up to the campaign and commit to delivering a safety plan that will contribute to the new ambition. This is an unprecedented and world-leading level of transparency and openness, which will help to create the right conditions needed to harness the commitment of everyone in the NHS to deliver the best and safest possible care.

Healthcare providers are being asked to the sign up safety campaign and make a public declaration of what they will do to improve safety in their organisations.

The five ‘Sign up to Safety’ pledges By signing up Trusts pledge a commitment to:

• Put safety first: Commit to reduce avoidable harm in the NHS by half and

make public the goals and plans developed locally.

• Continually learn: Make their organisations more resilient to risks, by acting on the feedback from patients and by constantly measuring and monitoring how safe their services are.

• Honesty: Be transparent with people about their progress to tackle patient safety issues and support staff to be candid with patients and their families if something goes wrong.

• Collaborate: Take a leading role in supporting local collaborative learning,

so that improvements are made across all of the local services that patients use.

• Support: Help people understand why things go wrong and how to put

them right. Give staff the time and support to improve and celebrate the progress made.

Individuals can also sign up to demonstrate their commitment.

Role of other national bodies

Monitor and the NHS Trust Development Authority are supporting this campaign and will coordinate their efforts to offer advice on sources of support, expertise and information to participating NHS Foundation Trusts developing their improvement plans for patient safety. The work of NHS Improvement Quality through the Patient Safety Collaborative Programme will also be aligned to this campaign.

The safety plans will be reviewed by the NHS Litigation Authority and if the plans are robust they will reduce claims. Trusts will also receive a financial incentive from the NHS Litigation Authority to support implementation of their plans. This can be used to tackle some of the financial costs of poor care.

The Care Quality Commission (CQC) has agreed to review trusts improvement plans for safety as part of its inspection programme. The CQC will not offer a judgment on the plans themselves but will consider them as a key source of evidence to demonstrate how Trusts are meeting the expectations of the five domains of safety and quality.

2. A Hospital Safety Website

NHS Choices is now providing key hospital-level patient safety data in one place which means the public can see how hospitals compare in terms of safety across seven key indicators. This is to ensure that hospitals are more transparent. The website provides hospital level patient safety data in a tabular form and Trusts can be compared against each indicator.

There are seven indicators, three of which are composites made up of subsidiary indicators and each indicator is or will be risk rated. The seven indicators cover the following: • CQC National Standards • Open and honest reporting • Infection control and cleanliness • Patients assessed for risk of blood clots • Responding to patient safety alerts

2

• Recommended by staff to their relatives and friends • Nursing and midwifery staffing levels

Safer Staffing Programme

In November 2013, the Government published ‘Hard Truths: the journey to putting patients first’, a full and final response to the Francis report which explicitly stated that poor staffing levels at Mid Staffordshire led to poor quality care. Whilst the government concedes that adequate staffing levels are essential in providing proper care, they will not be introducing mandatory staffing levels.

The National Institute for Health and Care Excellence (NICE) is currently in the process of developing guidance to the NHS on setting safe staffing levels. NICE will publish guidance for adult in-patient wards in July 2014 and from August for A&E, maternity units, acute in-patient paediatric/neonatal wards, mental health in-patient settings, learning disability in-patient units, mental health community units, learning disabilities in the community and community nursing care teams.

NHS organisations will be required to publish details of staffing levels on each of their wards every month, as well as the percentage of shifts meeting safe staffing guidelines. South Tyneside Foundation Trust (STFT), City Hospital Sunderland Foundation Trust (CHSFT) and Northumberland Tyne and Wear Foundation Trust (NTWFT) has confirmed that there is a process in place to capture this data and that they are on track to deliver this within the required submission timescales and the staffing data for will be included in future Quality reports. The June results are attached in appendix 1. This information will contribute to improving care for patients by ensuring that effective staffing levels are continually presented challenged owned and discussed at Board level, with the commissioners at the Clinical quality Review Group (CQRG) and at front line level.

3. Whistleblowing

This element is an independent review into creating an open and honest reporting culture in the NHS chaired by Sir Robert Francis QC. The review is being established to provide independent advice and recommendations on measures to ensure that NHS workers can raise concerns with confidence, that they will be acted upon, that they will not suffer detriment as a result and to ensure that where NHS whistle-blowers are mistreated there are appropriate remedies for staff and accountability for those mistreating them.

The review will consider the merits and practicalities of independent mediation and appeal mechanisms to resolve disputes on whistleblowing fairly. It will do this by listening to and learning the lessons from historic cases where NHS whistle-blowers say they have been mistreated after raising their concerns and by seeking out best practice. Further progress on this review will be reported when available.

3

http://https/francisresponse.dh.gov.uk/

http://https/francisresponse.dh.gov.uk/

Conclusion

STCCG will be encouraging the local Trusts to join the “sign up to safety” campaign and commit to putting safety first by publishing their safety improvement plans and reporting on progress, identifying areas of focus using national and local priorities and engaging with communities, patients and staff. Progress on this and the key hospital-level patient safety results will be monitored at the relevant CQRGs and assurance sought that the plans are robust, and any key risks identified and addressed with action plans. The results of this will be reported to the Quality Patient safety committee (QPS) and updates provided regularly to the governing body.

Recommendation/Action Required

The Governing Body is asked to note the contents of the report and seek clarification where required.

4

Appendix 1 South Tyneside District Hospital Results

The above data demonstrates that all the indicators for STFT are as expected; the safe staffing levels were 91% of the planned level. There may be various reasons for this that will be discussed at the CQRG.

5

http://www.nhs.uk/Services/hospitals/Overview/DefaultView.aspx?id=659

Safe staffing Why this fact is important: This measure shows the overall average percentage of planned day and night hours for registered and non-registered nurses and midwifes in hospitals which are filled. Things to note: This indicator is the average of four from the hospital level indicators published which are:

• Percentage of registered nurse day hours filled as planned (Hospital) • Percentage of non-registered nurse day hours filled as planned (Hospital) • Percentage of registered nurse night hours filled as planned (Hospital) • Percentage of non-registered nurse night hours filled as planned (Hospital) • The value may be greater than 100%. This will occur when the actual staffing

number is higher than the planned. This may be because there a lot of patients on the ward who need extra care due to their physical or mental health condition.

This data is taken from NHS England for 2014

6




REPORT TITLE: M2 Finance Report 2014/15 AGENDA ITEM: 2014/064 ENCLOSURE: 05


Name/Title: Kate Hudson, Chief Finance Officer South Tyneside Clinical Commissioning Group Tel/E-mail: 0191 283 2875 [email protected]

REPORT AUTHOR: Name/Title: Kate Hudson, Chief Finance Officer South Tyneside Clinical Commissioning Group Tel/E-mail: 0191 283 2875 [email protected]


M2 finance report detailing:- Programme and running cost budget performance for the period ended 31st May 2014. Movements in overall allocation detailed in the appendices. Also included is CCG performance on Prompt Payment Practice Code. For information, no recommendations.


Risk of financial over-performance on programme expenditure arising from activity pressures in both acute and community settings. Risks detailed within Risk section of the paper.


NO YES

If no please specify the reason why: Not applicable, report does not make any proposals - it is for monitoring and assurance purposes only.



For Information





Finance Report Month 2 (May) 2014/15

1. Reason for the Report

The purpose of this document is to; • Report on the financial position for the eleven months ended 31st May

2014 and provide an indication of the outturn position for the 2014/15 financial year.

• Provide assurance to the Governing Body of the CCG on delivery against key financial performance targets in 2014/15.

2. Current Performance The 2014/15 planned financial performance for South Tyneside CCG is a surplus of £1.1m – equivalent to 0.5%. In March the Governing Body endorsed the financial strategy to move to 1% cumulative surplus over three years. Appendix 1 shows the CCG position as reported nationally. The summary performance for the CCG is outlined below. The CCG forecast for the year end is achievement of £1.1m surplus.

Financial Target Target DetailYear to Date

Position Forecast Position

Revenue Allocation - Programme To keep expenditure within allocation Revenue Allocation - Running Costs To keep expenditure within allocation

Cash LimitTo keep cash outgoings within the cash limit

BPPCTo pay CCG creditors within 30 days of receipt of invoices or goods

Risk Rating Key Indicator

Meeting Target and Improving Meeting Target and Remaining Static Meeting Target and Declining Close to Target and Improving Close to Target and Remaining Static Close to Target and Declining Distant to Target and Improving Distant to Target and Remaining Static Distant to Target and Declining

The CCG performance to date and forecast position is included in the appendices to this document as follows:

• Appendix 1 - year to date and forecast income & expenditure reports • Appendix 2 - in year budget movements • Appendix 3 - DoH in year allocations • Appendix 4 - better payment practice code

Appendix 1 shows the CCG high level budget position for the CCG allocations on both the commissioning and running cost budgets. This appendix shows year to date (YTD) budget and expenditure together with annual position and forecast for the year end. For this report we received very little monitoring information from external sources, i.e. month 1 activity data, no prescribing forecast and no CHC reconciliation from the Council. Furthermore, it is not prudent to use only one month of information as the basis for a year end forecast. Therefore, at this stage it is assumed that all contracts are on track and delivery of 0.5% surplus is achievable. The running cost budgets are also assumed at break even. For additional clarity Appendix 2 details movements in budgets that have been transacted since opening budgets were agreed by the Governing Body. Appendix 3 details the CCG opening allocation. The CCG performance against the BPPC target is given in Appendix 4. This is a key performance area and will remain under review.

3. Risks Contract over-performance 2014/15 Activity information from our main providers is only available for April and for some providers, continues to present some data challenges. As a consequence this data will not be used as the basis of a forecast for the CCG at this point. Prescribing

Whilst the CCG increased the budget for prescribing for 2014/15 this continues to be a risk area as the funding may not have addressed cost/volume growth entirely. The Business Services Authority has not yet released month 1 prescribing data but nevertheless this would not be accompanied by a forecast position at this point CHC Whilst the CCG increased the budget for CHC packages for 2014/15 this continues to be a risk area. The CCG has not received any CHC information from the Council for 2014/15.

Page | 2

Spending 2.5% of budget non-recurrently This remains a low risk for the CCG as there are known pre-commitments and the CCG has an agreed prioritised plan for use of this funding. CCG QIPP Programme

The CCG has developed a QIPP programme delivering £1m of savings in 2014/15. The savings have all been delivered through contractual pricing changes at the start of the financial year. Running Costs

The CCG has a small running cost allocation, however there is a low risk of overspend.

4. Recommendation

The Governing Body is requested to: i) Consider this report and note the risks and the forecast position.

Kate Hudson Chief Finance Officer

Page | 3

APPENDIX 1

YTD Budget YTD Actual

YTD Variance (Under)/

Overspend Risk Rating2014-15 Budget

Forecast Outturn

Forecast Variance (Under)/

Overspend Risk Rating£000's £000's £000's £000's £000's £000's

South Tyneside NHS Foundation Trust 13,281 13,281 0 79,685 79,685 0 City Hospital Sunderland NHS Foundation Trust 3,421 3,421 0 20,524 20,524 0 Newcastle Upon Tyne Hospitals NHS Foundation Trust 1,746 1,746 0 10,477 10,477 0 Gateshead Health NHS Foundation Trust 1,197 1,197 0 7,183 7,183 0 County Durham and Darlington NHS Foundation Trust 285 285 0 1,709 1,709 0 Northumbria Healthcare NHS Foundation Trust 46 46 0 276 276 0 Leeds Teaching Hospitals NHS Foundation Trust 1,026 1,026 0 6,153 6,153 0 North East Ambulance Service NHS Foundation Trust 10 10 0 58 58 0 North East Ambulance Service NHS Foundation Trust - 111 0 0 0 0 0 0 NHS Non Contract Activity 298 298 0 1,788 1,788 0 Individual Funding Requests 0 0 0 0 0 0 Winter Pressures 0 0 0 0 0 0 Pass Through Payments - NHS Levies 0 0 0 0 0 0 Other Acute Providers 64 64 0 386 386 0 Other - Readmissions 261 261 0 1,564 1,564 0 Other - Transformation Fund 95 95 0 570 570 0

Mental Health Services Northumberland, Tyne and Wear NHS Foundation Trust 3,497 3,497 0 20,980 20,980 0 Tees, Esk and Wear Valleys NHS Foundation Trust 26 26 0 156 156 0 Other Providers / NCAs 283 283 0 1,701 1,701 0

Community Services South Tyneside NHS Foundation Trust - Community Health Services 2,862 2,862 0 17,174 17,174 0 Non NHS Healthcare 167 167 0 1,000 1,000 0 Voluntary Bodies 147 147 0 884 884 0 Misc Commissioning 209 209 0 1,254 1,254 0 Newcastle Upon Tyne Hospitals NHS Foundation Trust - Community Services 40 40 0 240 240 0 Carers 201 201 0 1,204 1,204 0

Continuing Care Other Providers 222 222 0 1,331 1,331 0 Local Authority 1,591 1,591 0 9,547 9,547 0 Local Authority - Childrens 183 183 0 1,100 1,100 0 Local Authority - FNC 120 120 0 720 720 0 Local Authority - Other 40 40 0 238 238 0 Local Authority - S117 MH 280 280 0 1,680 1,680 0

Primary Care Out of Hours 228 228 0 1,370 1,370 0 Prescribing - GP 4,433 4,433 0 26,597 26,597 0 Prescribing - Other 11 11 0 67 67 0 Prescribing - Drug Costs Met Centrally 80 80 0 478 478 0 Prescribing - PRIS 0 0 0 0 0 0 Enhanced Services 57 57 0 343 343 0 Referral Schemes 0 0 0 0 0 0

Other Corporate NHS Property Services 455 455 0 2,728 2,728 0 Safeguarding 82 82 0 492 492 0 PMS/GMS Unregistered Population 162 162 0 973 973 0

Commissioning Reserves Reserves 137 137 0 822 822 0 Non-Recurring Spend 848 848 0 5,085 5,085 0 Surplus 195 0 (195) 1,168 0 (1,168)

TOTAL (SURPLUS) / OVERSPEND 38,284 38,089 (195) 229,704 228,536 (1,168)

Acute Services (inc Ambulance Services)

Page | 4

WTE Budget WTE Actual YTD Budget YTD Actual

YTD Variance (Under)/

Overspend Risk Rating 2014-15 Budget Forecast Outturn

Forecast Variance (Under)/

Overspend Risk Rating£000's £000's £000's £000's £000's £000's

Running Costs

Admin Projects 0.00 0.00 8 8 0 50 50 0 Administration & Business Support 3.60 3.60 322 320 (2) 1,934 1,934 0 CEO / Board Office 3.40 3.00 82 75 (7) 492 492 0 Chair & Non Execs 0.00 4.10 22 16 (5) 130 130 0 Clinical Support 1.96 1.18 40 35 (5) 241 241 0 Commissioning 5.50 6.49 56 52 (4) 336 336 0 Education and Training 0.00 0.00 0 0 0 0 0 0

Estates and Facilities 0.00 0.00 13 14 1 80 80 0 Finance 1.74 1.44 38 29 (9) 228 228 0

Quality Assurance 1.90 2.39 35 38 2 211 211 0

617 587 (30) 3,702 3,702 0

Risk Rating Key Indicator

Meeting Target and Improving Meeting Target and Remaining Static Meeting Target and Declining Close to Target and Improving Close to Target and Remaining Static Close to Target and Declining Distant to Target and Improving Distant to Target and Remaining Static Distant to Target and Declining

Page | 5

APPENDIX 2

OPENING BUDGET

BUDGET AT MONTH 02

BUDGET MOVEMENTS

M02

COMMENTS ON BUDGET MOVEMENTS

OPENING ALLOCATION 222,913,000 222,913,000 0UPLIFT 4,828,338 4,828,338 0RETURN OF SURPLUS 513,000 513,000 0SPECIALIST COMMISSIONING 1,450,000 1,450,000 0

0TOTAL 229,704,338 229,704,338 -

ACUTE NHS INCL. AMBULANCE 0SOUTH TYNESIDE NHS FOUNDATION TRUST 79,690,561 79,685,292 (5,269) CORRECTION TO INITIAL CONTRACT VALUES

CITY HOSPITALS SUNDERLAND NHS FOUNDATION TRUST 20,523,502 20,523,502 0

NEWCASTLE HOSPITALS 10,477,270 10,477,270 0GATESHEAD HEALTH NHS FOUNDATION TRUST 7,261,009 7,182,984 (78,025) CORRECTION TO INITIAL CONTRACT VALUESNORTH EAST AMBULANCE SERVICE NHS TRUST 4,726,434 4,750,923 24,489 CORRECTION TO INITIAL CONTRACT VALUES

DURHAM UNIVERSITY HOSPITAL NHS FOUNDATION TRUST 1,672,432 1,709,419 36,987 CORRECTION TO INITIAL CONTRACT VALUES

NORTH EAST AMBULANCE SERVICE 111 CONTRACT 491,807 491,807 0

NCA'SNORTHUMBRIA HCARE NHST 276,065 276,065 0NHS - NON CONTRACT ACTIVITY 1,788,097 1,788,097 0

READMISSIONS 1,247,398 1,247,398 0OTHER ACUTE PROVIDERS 578,782 578,782 0TRANSFORMATION FUND 570,000 570,000 0

0TOTAL ACUTE 129,303,357 129,281,539 0 (21,818)

MH SERVICESNORTHUMBERLAND TYNE &WEAR NHS TRUST 20,979,989 20,979,989 0TEES ESK AND WEAR VALLEY NHS TRUST 156,165 156,165 0OTHER MH PROVIDERS 1,666,441 1,723,529 57,088 BUDGET ADDED TO FUND OTHER MH PROVIDERS

TOTAL MH 22,802,595 22,859,683 0 57,088COMMUNITY SERVICESCOMMUNITY HEALTH SERVICES (STFT) 17,170,800 17,174,024 3,224 BUDGET REALIGNMENTNEAS PATIENT TRANSPORT SERVICES 1,360,479 1,322,334 (38,145) BUDGET REALIGNMENTMSK SERVICE 1,001,640 1,001,640 0MISC COMMISSIONING 2,180,081 1,785,115 (394,966) BUDGET FOR OXYGEN CONTRACT

CARERS 1,144,030 1,203,865 59,835 ADDITIONAL BUDGET FOR STROKE ASSOCIATIONTOTAL COMMUNITY 22,857,030 22,486,978 0 (370,052)

CONTINUING HEALTH CAREOTHER PROVIDERS CHC 1,531,000 1,330,694 (200,306) BUDGET REALIGNMENTLOCAL AUTHORITY CHC S75 200,000 200,000 BUDGET REALIGNMENTLOCAL AUTHORITY CHC 8,587,000 8,587,000 0LOCAL AUTHORITY FNC 720,000 720,000 0LOCAL AUTHORITY S117 1,680,000 1,680,000 0LOCAL AUTHORITY CHILDRENS 1,099,000 1,099,000 0LOCAL AUTHORITY OTHER 998,000 998,000 0

TOTAL CONTINUING CARE 14,615,000 14,614,694 0 (306)PRIMARY CAREOUT OF HOURS 1,370,000 1,370,000 0PRESCRIBING - GP 26,409,090 26,409,090 0PRESCRIBING - OTHER 725,000 732,580 7,580 INITIAL BUDGET CORRECTIONOXYGEN 514,404 514,404 OXYGEN CONTRACT MOVED TO MISCELLANEOUSENHANCED SERVICES 343,000 343,000 0

TOTAL PRIMARY CARE 28,847,090 29,369,074 0 521,984OTHER PROGRAMMEREABLEMENT 316,925 316,925 0

TOTAL OTHER PROGRAMME 316,925 316,925 0 0OTHER CORPORATE NHS PROPERTY SERVICES 2,728,000 2,728,000 0PMS / GMS - UN REGISTERED POPULATION 973,000 973,000 0

TOTAL OTHER CORPORATE 3,701,000 3,701,000 0 0RESERVES 0NON RECURRENT RESERVE 4,572,028 5,085,028 513,000 BUDGET REALIGNMENT

COMMISSIONING RESERVE - IN YEAR ACTIVITY PRESSURES 501,722 (501,722) BUDGET REALIGNMENT

IN YEAR ACTIVITY ISSUES 42,815 135,640 92,825 BUDGET REALIGNMENT AQP IN YEAR PRESSURE 245,000 245,000 0COMMUNITY SERVICES FACILITIES STAFF 350,000 350,000 0FUNDING FROM CNTW AT - CHS DRUGS COSTS (177,000) (177,000) 0FUNDING FROM SUNDERLAND CCG - FACILITIES (315,240) (315,240) 0

FUNDING FROM GATESHEAD CCG- CHC RESTITUTION TEAM (121,779) (121,779) 0

FUNDING FROM SUNDERLAND CCG- CHC RESTITUTION TEAM

(168,037) (168,037) 0

HOME OXYGEN 41,000 (41,000) BUDGET REALIGNMENT£5per head GP 772,880 772,880 0DIABETIC SCREENING 100,000 100,000 0CCG INITIATIVES 250,000 (250,000) BUDGET REALIGNMENT0.5% CONTINGENCY - BALANCE 1,167,953 1,167,953 0

TOTAL RESERVES 7,261,341 7,074,445 0 (186,896)

TOTAL SOUTH TYNESIDE CCG 229,704,338 229,704,338 0 (0)

Page | 6

APPENDIX 3

CCG Allocation Recurrent Non Recurrent Total£000's £000's £000's

Confirmed Allocations: Total Allocation for CCG 232,893 0 232,893Running Costs Allocation (3,702) 0 (3,702)Return of 2013-14 Surplus 513 513

Total NHS England Confirmed Programme Allocation 2013-14 229,191 513 229,704

Total NHS England Anticipated Programme Allocation 2013-14 0 0 0Total NHS England Programme Allocation 2013-14 229,191 513 229,704Running Costs Opening Baseline 3,702 0 3,702Total Confirmed Running Costs Baseline 3,702 0 3,702Total NHS England Running Cost Allocation 2013-14 3,702 0 3,702Total Allocations 232,893 513 233,406

Page | 7

APPENDIX 4

Better Payment Practice Code - 30 Days NUMBER £000's

Non-NHSTotal Non-NHS Trade Invoices Paid in the Year 851 4,446Total Non-NHS Trade Invoices Paid Within 30 Day Target 838 4,407Percentage of Non-NHS Trade Invoices Paid Within 30 Day Target 98.47% 99.12%

NHS Total NHS Trade Invoices Paid in the Year 229 28,710Total NHS Trade Invoices Paid Within 30 Day Target 218 28,320Percentage of NHS Trade Invoices Paid Within 30 Day Target 95.20% 98.64%

BETTER PAYMENT PRACTICE CODE - SOUTH TYNESIDE CCG FOR THE TWO MONTHS TO 31 MAY 2014

Page | 8




REPORT TITLE: Performance Report AGENDA ITEM: 2014/065 ENCLOSURE: 06


Name/Title: Christine Briggs, Director of Operations South Tyneside Clinical Commissioning Group Tel/E-mail: 0191 283 1903 [email protected]

REPORT AUTHOR: Name/Title: Aaron Tucker, Commissioning Manager South Tyneside Clinical Commissioning Group Tel/E-mail: 0191 283 1903 [email protected]


The following report gives a summary of the performance at CCG level for NHS Constitution Indicators, CCG Outcome Indicators and CCG Quality Premium. The report provides threshold, actual and year to date performance with a trend line based on the last four available data points. In addition risk to year end performance is RAG rated with comments where an indicator is red or amber.


No risks identified.


NO YES




For Information





CCG Monthly Performance Report

July 2014

Introduction: The following report gives a summary of the performance at CCG level for NHS Constitution Indicators, CCG Outcome Indicators and CCG Quality Premium. The report provides threshold, actual and year to date performance with a trend line based on the last four available data points. In addition risk to year end performance is RAG rated with comments where an indicator is red or amber. 1. Issues to note constitution indicators:

1.1 The percentage of patients seen within two weeks of an urgent referral for breast symptoms. This indicator rated red in April with 46 of the 51 patients seen within target. Five patients breached due to patient choice.

2. Issues to note CCG outcome indicators:

2.1 Unplanned hospitalisation for asthma, diabetes and epilepsy (under 19s) – continues to be above trajectory even after data cleansing. The 2013/14 data is due to be refreshed due to revisions to the CCG mapping methodology. The BI team are awaiting further clarification from the Information Centre before this is actioned.

The CCG failed this target 2013/14.

2.2 Friends and Family – The Foundation Trust had seen an improvement

in the response rate for A&E. Rates increased from 4.7% in March to 13.3% in April. This has not been sustained and rates fell in May to 8.9%. The recommended response rate is 15%. Inpatient response rate had been stable and was reported at 42.9% in March and 42.6% in April. Unfortunately this has also fallen and is now reported at 35.5%.

2.3 Friends and family - A&E score improved from 39 in March to 57 in

April and has increased again to 71 in May. Inpatients score had increased from 79 in March to 83 in April, but has fallen in May to 76. For STCCG to achieve the quality premium STFT must deliver the nationally agreed FFT roll out plan to the national timetable and increase the average FFT score for both inpatient and A&E between Q1 13/14 and Q114/15.

2.4 The FT reported a number of reasons for the fall in A&E performance

in 13/14; staff absences including the housekeeper who monitors the collection; fluctuating activity in A&E; an increased number of distressed patients and inebriated patients in A&E; patients asked to

complete other questionnaires at the same time i.e. falls and alcohol consumption. Strategies implemented to improve performance at the FT include electronic tablets, the use of postcards, SMS, kiosks and online responses.

2.5 IAPT - Access has improved from 2013/14 and is currently above

target at 2.8% in May against a threshold of 2.5%. Recovery rate continues to perform well and is at 56.3% of people moving to recovery compared to the target of 50%. It should be noted that projected access outcomes are at 16.8% for South Tyneside CCG. However access improvement can be explained by definition change rather than increased referrals.

2.6 No incidents of MRSA have been reported May year to date. However

the CCG is reporting nine cases of CDiff at the end of May. This is above the trajectory of four cases. It should be noted that of the nine cases seven were community acquired.

2.7 Dementia diagnosis is a good new story with the diagnosis rate

reported as 71.9% exceeding the year end trajectory of 68.4%. 3. Dashboards

Following are dashboards illustrating the CCG’s position in relation to:

3.1 CCG Quality Premium for 2013\14 The value of the scheme (payable in 2014\15) is estimated to be £651k for the CCG; however the end of year position on MRSA and CDI is estimated to have cost the CCG approximately £93k. Regular reviews of this dashboard throughout the year enable us to follow this position.

3.2 NHS Constitutional indicators

Pressure areas are set out in the highlights section above. The dashboard allows an overview of all of the indicators.

3.3 NHS Outcomes Framework

Pressure areas are set out in the highlights section above. It should be noted that some of the datasets which sit within it are annually or bi-annually published.

Aaron Tucker Commissioning Manager 4 July 2014

CCG Population 148,788Measure

Title of MeasurePercentage of

quality premiumValue for CCG's Threshold for success Latest Data

Measure Achieved

Eligible QP Funding

Domain 1: Preventing people from dying prematurelyReduction in Preventable Years of Life Lost (PYLL) from causes amenable to healthcare

12.50% £ 92,993 ↓≥3.2% in the potential years of life lost (adjusted for sex and age) from amenable mortality in the calendar year 2013 compared to 2012.

Annual - £ 92,992.50

Domain 2: Enhancing quality of life for people with long term conditions

Domain 3: Helping people to recover from episodes of ill health or following injury.

Avoidable emergency admissions

25.00% £ 185,985

Indirectly Standardised Rate (ISR) of avoidable emergency admissions in 2013/14 ≤ ISR 2012/13 ORISR 13/14 < 1,000 admissions per 100,000 population

Avoidable emergency admissions Mar 2014 - 2640.7

- £ 185,985.00

Domain 4: ensuring that people have a positiveexperience of care. 12.50% £ 92,993

South Tyneside FT deliver the nationally agreed FFT roll out plan to the national timetable AND ↑in average FFT score for both inpatient and A&E between Q1 13/14 and Q1 14/15

May 14 scores & response STFT; IP -76 & 35.5% , A&E -71 & 8.9%

- £ 92,992.50

Domain 5: treating and caring for people in a safe environment and protecting them from avoidable harm. 12.50% £ 92,993

Zero MRSA assigned to the CCG AND↓C-Diff ≤ 30

May 2014 ytd MRSA- 0 May 2014 ytd C.Diff - 9

£ 92,992.50

Local Priority 1 - Emergency readmissions within 30 days of discharge from hospital 12.50% £ 92,993

A rate of emergency readmissions of 11.5% or less in 2013/14

£ 92,992.50

Local Priority 2 -Number of people in Nursing homes with a care plan 12.50% £ 92,993

100% of South Tyneside patients in a nursing home will have a review and a care plan.

- - £ 92,992.50

Local Priority 3 - People with COPD and Medical Research Council (MRC) Dyspnoea Scale >3 referred to a pulmonary rehabilitation programme

12.50% £ 92,993 ≥ 18.7% of patients with COPD and MRC scale ≥ 3 in 2013/14 referred for pulmonary rehab.

Q4 2013 ytd 28.2% - £ 92,992.50

TOTAL 100.00% £ 743,940 £ 743,940.00

Measure Achieved

CommentsAdjustment to

fundingYTD 94.1% Apr 2014 YTD 25%YTD 95.2% June 2014 YTD Performance 25%YTD 92.9% Apr 2014 YTD 25%YTD 74.4% May 2014 YTD (NEAS) 25%

Total AdjustmentRevised Total

£ - £ -

AchievementValue

Quality Premium Funding Adjustment

£ - £ -

NHS South Tyneside CCG Quality Premium 2013/14

NHS Constitutional rights and pledges

Referral to treatment times (18weeks)(Incomplete pathways 92%)

Natio

nal

Loca

l

A&E Waits (mapped data target - 95%)Cancer waits - 62 days (Target 85%)Category A Red 1 ambulance calls (NEAS target 75%)

£ - £ 743,940.00

Monthly Year endTrend risk

Threshold Actual YTD assessment

% of patients initial treatment within 18 weeks for admitted pathways 90.0% 94.2% 94.2%

% of patients initial treatment within 18 weeks for non- admitted pathways

95.0% 98.2% 98.2%

% patients waiting for initial treatment on incomplete pathways within 18 weeks

92.0% 94.1% 94.1%

Number of patients waiting more than 52 weeks for treatment 0 0 0

Diagnostic waits% patients waiting less than 6 weeks for the 15 diagnostics tests (including audiology)

Apr-14 1.00% 0.4% 0.4%

% patients spending 4 hrs or less in A&E or minor injury unit 95.0% 97.5% 97.9%

Over 12 hour trolley waits 0 0 0

% patients spending 4 hrs or less in A&E or minor injury unit 95.0% 93.0% 93.9%

Over 12 hour trolley waits 0 0 0

% of patients seen within 2 weeks of an urgent GP referral for suspected cancer

93.0% 94.7% 94.7%

% of patients seen within 2 weeks of an urgent referral for breast symptoms

93.0% 90.2% 90.2%

% of patients treated within 31 days of a cancer diagnosis 96.0% 100.0% 100.0%

% of patients receiving subsequent treatment for cancer within 31 days - surgery

94.0% 100.0% 100.0%

% of patients receiving subsequent treatment for cancer within 31 days - drugs

98.0% 100.0% 100.0%

% of patients receiving subsequent treatment for cancer within 31 days - radiotherapy

94.0% 100.0% 100.0%

% of patients treated within 62 days of an urgent GP referral for suspected cancer

85.0% 92.9% 92.9%

% of patients treated within 62-day of referral from an NHS cancer screening service

90.0% 100.0% 100.0%

% of patients treated for cancer within 62 days of consultant decision to upgrade status

N/A N/A N/A

Category A (Red 1) 8 minute response time 75.0% 95.5% 85.7%

Category A (Red 2) 8 minute response time 75.0% 80.2% 80.2%

Category A 19 minute transportation time 95.0% 98.0% 98.2%

Mixed Sex accommodation

Mixed Sex accommodation - number of unjustified breaches May-14 0 0 0

Care Programme Approach

% people followed up within 7 days of discharge from psychiatric in patient care

Q4 2013/14 95.0% 97.3% 97.8%

No issues to note

No issues to note

Apr-14

May-14

A&E - South Tyneside FT

No issues to note

Performance increased slightly in March to 96.2% but fell just below target to 94.8% in May and fell again to 93% in June.A&E - City Hospitals

Sunderalnd

Jun-14

No issues to note

No issues to note

No issues to note

No issues to note

No issues to note

No issues to note

No issues to note

46/51 patients seen within target. 5 patients breached due to patient choice.

No issues to note

No issues to note

No issues to note

No issues to note

No issues to note

No issues to note

No issues to note

NHS South Tyneside CCG Performance Indicators 2014/15 - NHS Constitution

Comments

No issues to note

CCGNHS South Tyneside CCG

Latest Data Period

Domain Indicators Indicator Description

NHS

Con

stitu

tion

Indi

cato

rs

Referral to treatment access times

Ambulance

Cancer Waits

Apr-14

Threshold date Threshold

Latest Data Period Actual

Risk Assessment

Under 75% mortality rate from cardiovascular disease 79.56 82.42

Under 75% mortality rate from respiratory disease 34.71 49.04

Under 75% mortality rate from liver disease 23.36 27.92

Under 75% mortality rate from cancer 167.36 165.04

Health related quality of life for people with LTC TBCData still to be

sourced

Proportion of people feeling supported to manage their long term condition Mar-12 74.41 Mar-13 72.7%

Unplanned hospitalisation for chronic ambulatory care sensitive conditions (QP) Mar 2014 ytd 1183.0 Mar 2014 ytd 1080.1

Unplanned hospitalisation for asthma, diabetes and epilepsy (under 19s) (QP) Mar 2014 ytd 384.9 Mar 2014 ytd 412.8

Estimated diagnosis rate for people with dementia 2013/14 68.4% Q4 2013/14 71.9%

Emergency admissions for acute conditions that would not usually require hospital admission (QP)

Mar 2014 ytd 1739.0 Mar 2014 ytd 1501.0

Emergency readmissions within 30 days of discharge from hospital 2010/11 12.8

Total health gain assessed from patients i. hip replacements 0.41 0.38

Total health gain assessed from patients ii.knee replacements 0.29 0.27

Total health gain assessed from patients iii Groin Hernia 0.08 0.08

Total health gain assessed from patients iv varicose veins 0.06 0.00

Emergency admissions for children with LRTI (QP) Mar 2014 ytd 354.8 Mar 2014 ytd 339.4

Patient Experience of GP Services Sep-12 92.29% Mar-13 91.8%

Patient experience of GP & OOHs services Sep-12 72.73% Mar-13 77.0%

Patient experience of hospital care

Friends and family test (QP) Response rate - A&E May-14 15.0% May-14 8.9%

Friends and family test (QP) Response rate - IP May-14 15.0% May-14 35.5%

Friends and family test (QP) Response rate - Maternitystarted in Oct -

13

Friends and family test (QP) Score - A&E May-14 n/a May-14 71

Friends and family test (QP) Score - IP May-14 n/a May-14 76

Friends and family test (QP) Score - Maternitystarted in Oct -

13

Increase percentage people with anxiety disorders and depression who access psychological therapies (IAPT)

May 2014 ytd 2013/14

2.5%May 2014 ytd

2013/142.8%

IAPT Recovery RateMay 2014 ytd

2013/1450%

May 2014 ytd 2013/14

56.3%

Incidence of MRSA (QP) May 2014 ytd 0 May 2014 ytd 0

Incidence of C Diff (QP) May 2014 ytd 4 May 2014 ytd 9

Local Priority 1 - Emergency readmissions within 30 days of discharge from hospital 2013/14 <=11.5%Local Priority 2 -Number of people in Nursing homes with a care plan 2013/14 100%Local Priority 3 - People with COPD and Medical Research Council (MRC) Dyspnoea Scale >3 referred to a pulmonary rehabilitation programme 2013/14 ≥ 18.7% Q4 2013/14 ytd 28.2%

No update

Friends and family rates continue to be above the 15% mandated response rate for IP, however there has been a drop in the A&E response rate from 8.3% Feb, to 4.7% in March. This improved in April to 13.3% but fell in May to 8.9%. IP response rate has fallen slightly from 42.6% in April to 35.5% in May.

Friends and family net promoter score continues to be monitored there is no mandated target for this however to achieve the Quality Premium on this indicators there needs to be an increase in average score for both inpatient and A&E between Q1 13/14 and Q1 14/15.

The % of people who access IAPT has improved from the end of March and is above target in May. The recovery rate for IAPT is also above target at the end of May with 56.3% of people moving to recovery compared to the target of 50%.

2012

Local Quality Premiums

Local

QP

No updateNo update

Target achieved for this local trajectory

2011/12

2011Information on Mortality indicators has recently been published and shows that mortality for CVD, Respiratory and Liver disease have all increased with Cancer show a very slight drop.

No update

The Proportion of people feeling supported to manage their long term condition has fallen between March 2012 and 2013.

The data for this indicator has been recalculated after the problems with Gateshead FTs data. Gateshead FT have submitted a full refresh of 13/14 data and all duplicates have been removed. However the indicator remails below threshold. Dementia diagnosis has exceeded trajectory at the end of 2013/14.

No update

No Cases of MRSA has been reported against the CCG. C.diff cases May ytd are above trajectory. 9 cases compared to trajectory of 4 (year end target 31). 7 cases were community acquired.

NHS South Tyneside CCG Performance Indicators 2013/14 - Outcomes FrameworkNH

S Outc

omes

Frame

work

Enhancing Quality of life for people with LTC

Domain Indicators Indicator Description

Treating and caring for people and protecting from avoidable harm

NHS South Tyneside CCG

Mar-13

Positive Experience of care

Comments

Preventing people from dying prematurely

Helping people recover from episodes of ill health or following injury




REPORT TITLE: 2014/15 Planning Update AGENDA ITEM: 2014/066 ENCLOSURE: 07


Name/Title: Christine Briggs, Director of Operations South Tyneside Clinical Commissioning Group Tel/E-mail: 0191 283 1903 [email protected]

REPORT AUTHOR: Name/Title: Mark Girvan, Commissioning Manager, SPR North of England Commissioning Support Unit (NECS) Tel/E-mail: 0191 217 2528 [email protected]


This paper provides members with an update on progress with the 2014/15 planning cycle, including detail of the final submission of the Better Care Fund and five year operational plan. The paper illustrates that the CCG’s five year plan submission – the Key Lines of Enquiry – was made to NHS England by the timescale of 20th June. Prior to its finalisation, the Executive and Governing Body met to review the outcome ambitions and trajectories and some adjustments were agreed. These were reflected in the submission and the detail is set out within the report. Whilst it is not a national requirement to produce a plan document, we are working on a planning document which will be published at the end of July, which will articulate our agreed five year aspirations for the benefit of internal and external stakeholders. An update is provided around the Better Care Fund and the requirement to create a pooled budget, noting that further detail around next steps awaited from national sources; however, in the meantime we continue to progress at pace the four transformation workstreams connected with integration and a detailed update is provided. The report also includes a progress update around the 8 high impact interventions aimed at reducing current health inequalities casued by the ‘3 clinical challenge areas’ of Cancer, Respiratory and Circulatory disease. The Governing Body is asked to note the content of this report and the progress made to date.


Not applicable.




NO YES

If no please specify the reason why: This paper is for update purposes only. An equality impact assessment will be completed as part of the development of the 5 year plan.



For Information



NHS Public

2014/15 Planning update South Tyneside CCG Governing Body- July 2014

Page 1 of 14

NHS Public

Table of Contents 1. Introduction ................................................................................................................... 3

2. Integrated care - Better Care Fund................................................................................ 3

3. 2014/15 Planning requirements..................................................................................... 5

4. Specific challenges: Cancer, cardio vascular and respiratory disease .......................... 8

5. Action needed and next steps ....................................................................................... 8

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NHS Public

1. Introduction This paper provides Board members with a progress update on the 2014/15 planning cycle. It follows on from the update submitted in May and outlines the current situation regarding Better Care Fund, as well as the South Tyneside system five year plan.

2. Integrated care - Better Care Fund As reported in the update presented in May, the final Better Care Fund (BCF) for South Tyneside was submitted in line with national timescales on Friday 4th April. The BCF is a single pooled budget aimed at supporting health and social care services to work more closely within local areas. Every locality was tasked with developing a BCF plan in order to support the increased delivery of care in the community and a subsequent reduction in activity in secondary care, as well as permanent reductions in residential and nursing care. As yet we have not received any feedback specifically in relation to the South Tyneside plan, however we are aware that nationally there are some concerns around BCF plans generally, for the following reasons:

• Financial viability of proposed initiatives; • The evidence or assumptions which underpin the proposed changes; • Whole system sign up to the plans.

Although we haven’t received feedback on the content of South Tyneside’s plan we are confident that the continued development of our local BCF plan, overseen by the integration board, will demonstrate a whole systems contribution and sign up to its vision and proposals. In addition cross triangulation with finance has been central to the development of our plans and we are currently carrying out work to risk assess our plans. We feel that this will place us in a stronger position at the point when additional guidance becomes available around next steps. NHS England are now working with 14 health and wellbeing boards form across the country to submit revised BCF plans on a fast track timetable to determine whether they can be assured and made available as exemplars for the rest of the country; it is likely that only 4 or 5 sites will be chosen. Within the North Region, Sunderland, Rotherham, Liverpool and Leeds have been selected as part of the 14 sites. Additionally a new template and best practice guidance has been published which our integrated board will now consider. In the interim we have continued to work at pace on implementing our four transformation schemes for the integration of care, which will provide better support at home and earlier treatment in the community to prevent the need for emergency care or care home admission: Integrated Community Teams

Health and social care teams which work around the patient • The first two workshops have been held around the development of

integrated community teams. • There was an excellent turn out at both workshops from partner

Page 3 of 14

NHS Public

organisations, with a focus around development a shared purpose for integrated community teams and developing a number of themes which need to be addressed when developing and implementing integrated community teams.

• The work is being supported and facilitated by NHS Improving Quality (NHSIQ)

• The aim of the work is to allow teams to work in an integrated way, which place the persons’ needs at the centre. Opportunities present for community teams and general practice to connect more closely in a person centred way.

• Integrated community teams should take in to account community nursing teams, social care and mental health workers, as well as community pharmacy and the third sector.

• We aim to also to embed the pioneer programme self-care offer into the way in which these teams work.

• This will result in better care for the person, a better experience and potentially reduced admissions to hospital and residential/nursing care.

Self-Care –South Tyneside is an integration pioneer

• An innovative approach to supporting people to have the skills, knowledge and confidence to look after themselves more effectively

• We are hosting a series of workshops to discuss, shape and embed the skills and knowledge of self care in both staff and the public. These workshops will begin in Hebburn and will be soon after rolled out to other areas of South Tyneside

• The first workshop was held on 26th June which was well attended with members of the public and a varied cross section of staff from across the health and social care system in South Tyneside.

• An expression of interest for a series of training workshops is being prepared and should be released within the next week with the aim to have the provider in place within a month

Change for Life Programme (LA led)

Work to transform lifestyle and preventative services, aiming to reduce health inequalities and improve health outcomes • This project looks to develop a streamlined Change4Life (C4L) service

incorporating all lower level lifestyle health improvement services allowing easy access via a Standardised Point of Access (SPoA) and support to individuals to address the cumulative effect of unhealthy lifestyle choices which are significant in the lower socioeconomic groups in South Tyneside.

• The Change4Life wellbeing model is in the process of being formally established.

• This project will be more widely publicised in the coming months.

Integrated hub (LA led)

Work which provides a new model of care for people with dementia from early diagnosis to end of life • An innovative and multifunctional facility: the hub will operate as a

partnership, providing a range of services across the four tiers of our demand management strategy. Services include respite, reablement, step up/step down provision, information and advice for clients and carers, early help services and in-house domiciliary care services.

• The competitive tender is completed; a public announcement be made soon.

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We will continue to work with local partners to implement these schemes whilst awaiting further guidance form NHS England re feedback from the early implementer sites for BCF Plans.

3. 2014/15 planning requirements In line with local and national timescales the CCG has undertaken a number of submission and review exercises of both our two and five year plans. On 20th June we made submission of our five year strategic plan Key Lines of Enquiry and supporting documentation. As reported previously, part of this submission required submission of five year trajectories which highlight our ambition for improving health outcomes against a number of specific indicators which are focussed around the 5 domains within the NHS outcomes framework. As shared at the Governing Body/ Executive Planning session held in July, in response to the penultimate submission these trajectories, the Area Team queried the ambition within two of our initiatives:

• Improvements for people with Long Term Conditions (LTCs); • Improvements to people’s experience of hospital care.

On review we identified a discrepancy with the baseline position of the second of these trajectories (this was due to a national amendment as to how the baseline was calculated). As such the baseline was recalculated and whilst no changes were made to the percentage improvement, a new submission was made accordingly. With regards to the improvements for people with LTCs the feedback received (highlighted in the graph below) demonstrated that the current trajectory for this metric meant South Tyneside were one of the least ambitious CCGs in the country in terms of predicted improvement. At the Executive/Governing Body planning session, we therefore reviewed all trajectories, and the LTC submission specifically. It was agreed that the levels of ambitions should be increased for the final submission to move South Tyneside into the higher ambition quadrant. The final trajectories for South Tyneside therefore are:

Reducing the potential Years of Life Lost • 3.2% improvement in 2014/15 with a 2.4% annual improvement thereafter • 5 year plan includes close collaboration with Public Health to;

• Focus on early identification and prevention • Increased management of conditions across primary and community services, through

transformed primary care and integrated community teams • Increase number of completed health checks (focussing on hard to reach groups-

particularly males) • Implementation of a new service specification for pulmonary rehabilitation • Increase referrals to pulmonary rehab

Page 5 of 14

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• Review stroke services • Focussed work on reducing variation in primary care • 3.2% in year 1 will equate to 80 years of life saved

Enhancing quality of life for people with long term conditions

• 0.2% in years 1 and 2, 0.5% in year 3&4 and 1% increase in year 5 • We feel that work completed in 2013/14 around improved identification of people with LTCs will

help support the delivery of this trajectory, also drawing on lessons learned from out South Tyneside Improving Care Scheme (STICS).

• We also feel that STCCGs Pioneer project will support our delivery of this trajectory through promotion of self care

Reducing emergency admissions • There is a national requirement to reduce emergency admissions by 15% by 2018/19. We aim

to achieve this via a stepped approach with a 3% improvement year on year. This will be delivered via:

o The implementation of the BCF plan o An increased focused on the conditions that can be treated in ambulatory care pathway o Focused work with primary care to better manage patients in the community o The utilisation of CQUIN as a lever to improve care of children with asthma, diabetes

and epilepsy o The implementation of the unplanned care DES o Improved use of community pathways, for example DVT and cellulitis

Positive experience of hospital care • 1% increase year on year over the next 5 years • Limited improvement rate due to high baseline position

Positive experience of care outside of hospital

• 0.1% year on year improvement • Limited improvement rate due to high baseline position Integration vision for South Tyneside health and social care partnership The integrated vision for South Tyneside is a key component of the five year plan and it summarises how we intend health and social care services to look and feel in five years time. This vision has been developed by, and signed up to by all key stakeholders: Central to our five year plan is our integration vision and new plan on a page.

I can promote my own health and wellbeing by planning my care & support with

people who work together to understand me and my carers, allow me control and bring together services to achieve the outcomes important to me.

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Plan on a page This has been collaboratively developed, tested with stakeholders and approved (see over):

Whilst the required submission of Key Lines of Enquiry for our five year plan was made in June, it is our intention to publish a planning document which illustrates in a visual way our agreed five year aspirations. This will be published at the end of July and is currently being finalise

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d. Copies will be circulated internally and externally.

4. Specific challenges: Cancer, cardio vascular and respiratory disease

As reported previously, during the planning round a range of information sources were used to highlight health inequality challenges. This helped steer our direction of travel to ensure resources are focused on improvement areas which will have the greatest impact in reducing health inequalities and potential years of life lost, and thus links closely with the outcome ambitions described above. Furthermore, work has continued over the last couple of months to review progress with ‘8 high impact’ initiatives that were developed in 2010 to begin to address the challenges posed by these three conditions, the detail of which is set out in the Appendix. It can be seen that there are a number of projects and actions identified in relation to many of the original 8 priority interventions however we continue to review gaps and potential opportunities. Work will continue with colleagues in NECS and Public Health at the Local Authority to take forward these initiatives, however, early agreement has been reached that there will be a specific focus on Cancer, through the development and delivery of the Cancer Strategy. In particular the 2014/15 Better Outcomes GP Scheme has a key focus on cancer, as well as CVD and respiratory disease.

5. Action needed and next steps The Governing Body is asked to

• Endorse the content of this report and the progress made to date;

• Review, at its meeting in September, the published planning document which illustrates in a visual way our agreed five year aspirations

Paper author: Mark Girvan- Manager, Service Planning and Reform, NECS Sponsor: Christine Briggs- Director of Operations, South Tyneside CCG Completed: 11 July 2014

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Appendix – reducing health inequalities 8 high impact interventions - update Progress is as follows with regards to the ‘8 high impact’ initiatives which were developed in 2010 by the former PCT: NHS Health Checks

• Rolled out to GP practices in 2010/11. Currently 29 GP practices signed up (20 using POCT). There is significant variance across practices in delivery of this service.

• Rolled out to community pharmacies in 2010. Currently 11 community pharmacies signed up to deliver service but only 5 are delivering. Uptake has declined.

• A Community Delivery Team was commissioned in 2010 to deliver NHS Health Checks in the community, including workplaces and festivals. This contract was in place for 3 years and ended on 30th June 2013.

• Despite a successful rollout and high activity initially, more recently there has been a significant decrease in the number of health checks being carried out.

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• Community Incentive Programme - ST are now buying in dedicated Nurse time as

part of this programme and have 9 community organisations supporting the delivery of HC’s and numbers from July are picking up.

• Media campaign. 4 Treatment Post MI – consistent treatment of patients after a circulatory disease event using; Beta blocker, Aspirin, ACE inhibitor, statins

• A baseline audit was completed in 2010 and reviewed again in 2011. The audit showed that, consistent with the research evidence, around half of patients who had an MI did not receive the optimum combination of medicines care to prevent them from having a further potentially fatal complication. One major explanation which was identified was the high contraindication rate. Even taking contraindications into account, around a quarter of patients with established CVD were not benefitting from the health benefits of combination drug treatment and the reasons for this apparent omission are not clear.

• Awareness sessions were completed with Primary Care in 2011. • This data collection and dashboard was discontinued in South Tyneside following

discussions with the Public Health team in 2012. The data is still being collected on a quarterly basis from practices; however this data is not being analysed and presented back to practices.

Cardiac Rehabilitation to be systematic

• A Rapid Process Improvement Workshop (RPIW) was carried out in September 2010 to standardise the cardiac rehabilitation pathway, improve access and quality, and put the patient at the heart of the process.

• The current pathway aligns with BACR, and utilises 4 stages of care post cardiac event. STFT deliver stage I and II of the pathway whilst South Tyneside LA Exercise Referral team delivers stage III and IV.

• There is currently no service specification in place to cover the whole cardiac rehabilitation pathway. A draft specification to cover the whole pathway was developed in 2011 but was not implemented.

• The current services commissioned from STFT and ST LA have been rolled over.

0200400600800

100012001400160018002000

Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3

2010/11 2011/12 2012/13 2013/14

Num

ber o

f Hea

lth C

heck

s

Total Number of NHS Health Checks July 2010-December 2013

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COPD treatment to be systematic with an appropriate target for local circumstances

• Health needs assessment completed in 2011. • STICS: o Improving the quality of chronic disease registers for COPD. o Identifying of a group of COPD patients who are seldom seen or who may be

accessing secondary care without accessing support by the practice. o Practices visiting patients to have a shared decision making discussion with

them around their condition(s). This will enable the discussion with patients around ways that these patients can be supported to manage their condition better – Self Care, access to appropriate community services etc. As well as putting in place key preventative measure such as rescue medication for COPD patients and other best practice interventions which will support that patient more effectively. As part of this practices will complete a standard STICS template in practice.

• Pulmonary Rehabilitation: o Review of current status and options appraisal completed in 13/14. No

further work has taken place. Has been rolled over into 14/15. o Quality Premium indicator for 13/14 - People with COPD referred for

pulmonary rehabilitation. Increased referrals via STICS – trajectory 18.7%, 17% referred up to June 2013.

Diabetes best practice developed and extended with an appropriate target developed for local circumstances.

• Intermediate Care Service • Finalised and developed action plan for implementation of diabetes model

including patient education in 2011. • Business Case for One Stop Shop developed and approved by STCCG

Executive Committee in May 2013. Atrial Fibrillation – identification and management of AF

• Review of evidence base for opportunistic and routine assessment of AF in Primary Care completed in 2011. Decision taken to pilot a Pulse Checks Local Enhanced Service (LES) with practices.

• Pulse Checks LES - ran for 3 years (2011/12 – 2013/14). Practices were paid £2 per pulse check undertaken on each patient who met the criteria. Evaluation completed and shared with CCG. As part of the LES review, undertaken in 2013, the decision was made that from 2014/15 onwards practices will no longer be paid to undertake this service.

• Procurement of a community based anticoagulation service for non-complex patients - procured via AQP in 2012/13. 3 providers qualified to deliver in South Tyneside, however to date only 1 has mobilised (STFT).

• Implementation of GRASP-AF - tool rolled out to all practices in 2012. Each practice received a 1:1 training and data collection visit. This was included as one of the Q&P QOF indicators for South Tyneside in 12/13, where practices were required to review patients who were not on an oral anticoagulant.

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Stroke establishing access to TIA clinics across NHS SOTW in line with best practice.

• SOTW model for Stroke / TIA care implemented in 2011/12. Access to TIA clinics across SOTW implemented in line with best practice.

• Stroke: o Each Trust provides all necessary acute and rehabilitation services o Office hours acute stroke assessment is provided by STFT team o Out of hours acute stoke assessment is provided by an on call consultant to all

3 Trusts using telemedicine assessment o Agreed pathways exist across the Northern Region for referral to tertiary

centres for intra-arterial therapies. o Weekend stroke admissions are reviewed on each day by the on call stroke

consultant • TIA: o High risk TIA referrals are seen on Saturday and Sunday in a clinic at City

Hospitals Sunderland. • Performance: o 90% of time spent on stroke ward: Local target of 80% introduced. Only

achieved ≥90% twice in year (up to month 9). o TIA patients assessed and treated in 24 hrs: Target of 60%. No data since

June. Failed to hit target in first 2 months of 13/14. Cancer early awareness and detection

• Be Clear on Cancer campaigns underway. • Cancer Screening programmes in place. • Significant variation across practices around referral and conversion rates. • Clinical Lead undertakes annual visits to each practice. • Flexi-sig rollout complete (bowel scope screening). • CQUIN – Smoking cessation • Workshop took place on March 10th to look at the systematic delivery of

interventions to reduce cancer mortality and increase cancer survival. • Bi-monthly cancer locality group in place with multiple partners. • 6 monthly SoTW cancer meeting to share learning and best practice across

Gateshead, South Tyneside and Sunderland. A number of pieces of work have already been identified during the planning and development of Commissioning Intentions for 2014/15, as well as the CCG 2 year and 5 year plans.

NHS Health Checks

• Double the overall uptake of NHS Health Checks in South Tyneside by: o Improving consistency of delivery and reduce variation in uptake. o Introducing new and innovative ways (including community based

interventions and improved marketing) to increase uptake among those at highest risk of CVD (men, patients in practices serving deprived areas, people with LD, people with SMI and people from South Tyneside BME groups).

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• Develop integrated pathways from the NHS Health Check programme into the emerging C4L service to reduce CVD risk.

• Correct management of “at risk” patients through appropriate treatment and referral into accessible services.

Cardiac Rehabilitation

• Commissioning Intentions 14/15 - Develop and implement specification to cover whole pathway.

• CQUIN 14/15 for Heart Failure - Reduce unnecessary hospital admissions and ensure patients feel supported via multi- disciplinary working, and coordinated care.

COPD

• Commissioning Intentions 14/15 - Review and implementation to ensure best practice for patients requiring pulmonary rehabilitation.

• CQUIN 14/15 - An agreed proportion of patients admitted with a COPD exacerbation should be discharged with a completed COPD discharge care bundle.

• Primary Care Scheme 14/15 (currently DRAFT) - Identifying the cohort of patients over 35 who smoke and have recorded cough or chest infection in the last 12 months and screen for COPD with spirometry.

• Primary Care Scheme 14/15 (currently DRAFT) - To review patients receiving prescriptions for inhalers who are not on the COPD/asthma register.

• Primary Care Scheme 14/15 (currently DRAFT) - Implement personal management plan supported with written material

• Primary Care Scheme 14/15 (currently DRAFT) / QP Indicator 14/15 – People with COPD referred for pulmonary rehabilitation.

Diabetes

• Commissioning Intentions 14/15 - Implementation of the business case to introduce a one stop shop for diabetes services in South Tyneside.

Atrial Fibrillation

• Procurement of a community based anticoagulation service for non-complex patients - AQP window is reopened on 17th March to increase choice.

Cancer early awareness and detection • Primary Care Scheme 14/15 (currently DRAFT) - To actively support the national

screening programmes and advertising campaigns through wider use of social media and technology including texting patients.

• Primary Care Scheme 14/15 (currently DRAFT) - Consider validated cancer risk tool opportunistically.

• Following a successful cancer workshop on the 10th March 2014, to look at the systematic delivery of interventions to reduce cancer mortality and increase cancer survival, a number of priorities were identified. A Cancer Strategy will be developed over the coming months with a full work plan sitting behind it. The Cancer Locality Group will be responsible for ensuring that the identified work areas are on track and delivered within identified time periods.

Atrial Fibrillation

• Pulse checks at chronic disease management appointments and flu vaccinations.

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• GRASP-AF work reignited in practices using RAIDR. • Audit of increase in patients on anticoagulants.

Stroke

• Review of Stroke / TIA services in light of poor performance issues. • Discussions with Gateshead CCG re their review that will be undertaken and

their possible plans to depart SOTW model.

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REPORT TITLE: Update on Public Health and Health and Wellbeing Board



Joint Report of Director of Public Health and Corporate Director Children Adults and Families South Tyneside Council

REPORT AUTHOR: Name/Title: Janice Chandler, Public Health Commissioning Lead South Tyneside Council Tel/E-mail: 0191 424 6551 [email protected]


This report provides an update on public health support to the Clinical Commissioning Group and current developments of the Health and Wellbeing Board.


No financial risks identified.


NO YES




For Information




Title: Update on Public Health and Health and Wellbeing Board Director of Public Health Date: 10/07/14

1. Purpose of Report This report is to update the Governing Body in relation to public health and the Health and Wellbeing Board

2. Public Health

The Public Health team have continued to work closely with the Clinical Commissioning Group over the past two months delivering against the mandated service for advice and information to the CCG. The work has been concentrated on the following areas:

• Cancer Strategy Cancer is responsible for the early deaths of about 250 South Tyneside Residents each year, and accounts for 40% of the gap in mortality between the borough and England as a whole. Partnership working to look at health inequalities and early mortality has resulted in an increased focus on cancer work in recent years. A well-attended stakeholder workshop in March presented the stark picture – including an independent external challenge – and considered priority interventions to tackle cancer in South Tyneside. As a result, a 5-year Partnership Cancer Strategy was drawn up and has now been endorsed by South Tyneside Council, the CCG and South Tyneside Foundation Trust.

Some key elements of the strategy are:

An audit of the whole care pathway, initially for lung cancer, to identify areas for improvement

Application of evidence and data to target high risk communities for screening and awareness interventions

Contact Officer: Janice Chandler, Public Health Commissioning Lead

information information information information information

Embed cancer awareness into Change4Life and all health

improvement work

Including cancer as a major focus of the GP outcomes improvement scheme

The cancer locality group will be responsible for the implementation of the strategy, and will report to the CCG’s Executive Committee and to the Health and Wellbeing Board.

• Suicide Audit A suicide audit has been completed producing a profile of the individuals who have taken their own life in South Tyneside over the period 2011 to 2012. The

Purpose of the audit is to identify common factors which may help to target possible future interventions. Previously, the South of Tyne and Wear Suicide Audit compiled within the Primary Care Trust has used a methodology of reviewing deaths according to the verdict given by the Coroner. However, concern has previously been expressed that this might fail to include a number of deaths with an element of self-harm where this is not captured in the Coroner’s verdict. To address this, this audit has used a different methodology to ensure that this information is captured. However, this means that there is discontinuity in the audit methodology, and that the results of this audit cannot be reasonably compared with those of previous audits.

The Coroner’s office holds a register of deaths where self-harm has been identified as a factor. The Coroner’s documentation was reviewed for all deaths in South Tyneside between 2011 and 2013 which appeared on this register. This register does not include deaths for which the inquest in still open; it is likely that this includes a number of deaths late in 2013.

The Coroner’s documentation contains personal information about individuals at a sensitive and vulnerable time of their lives and the public health team is conscious of the sensitivity of this documentation, and the privilege associated with accessing it.

Once the report has been finalised it will be circulated through the normal channels and presented to the CCG in full.



• Sexual Health Review The responsibility for the provision of sexual health services passed as a mandatory responsibility to the Local Authority from the PCT in April 2013 as part of the Transforming the NHS agenda.

As part of Public Health review programme and the Securing our Financial Future plans, a review of all commissioned sexual health services is being undertaken

However it is important to use this opportunity to look wider than simply reviewing what we already commission in terms of effectiveness and value for money. We also need to examine the broader sexual health needs of the overall population and identify across the life course how we want services to look in the future

This is a very challenging piece of work, as the transition for sexual health has been complicated. Services are split between commissioning bodies, for example, contraceptive services sit with the Local Authority while termination of pregnancy services sits with the CCG.

An additional complication is that the financial arrangements are not clear particularly around drug costs and recharge arrangements and can differ from area to area in terms of pricing and responsibility.

However South Tyneside has an excellent reputation for the joined up working it undertook to reduce teenage conception rates which we have maintained to remain the best in the region. It is this understanding and experience of partnership working which will be built upon to accommodate the wider sexual health agenda.

The review will address four key areas

• Identification of need across the age range including prevention early intervention

• Financial and commissioning arrangements



• Adherence of current services to national standards • Development of an integrated future delivery model

It is anticipated that the review will be completed in October 2014

• Dental Health Research has been carried out showing as expected that dental disease is common. While dental diseases are rarely fatal, they cause a substantial burden of illness and distress, and consume more healthcare resource than cardiovascular disease and cancer. There is strong evidence to show that a large proportion of dental disease can be prevented through basic dental hygiene. The dental health of five-year olds in South Tyneside is considerably better than the North East and England averages: a smaller proportion of five year olds in South Tyneside have decayed, missing or filled teeth compared to the national and regional averages, and those children with decayed, missing, or filled teeth have fewer teeth affected. There is, however, a substantial level of inequality between wards.

The dental health of adults in the North East is slightly worse than the England average, but it is not clear what this means for South Tyneside specifically – it may be that South Tyneside outperforms regional peers, as with the dental health of children. Access to NHS dental service in South Tyneside appears good, though there is some variation between wards.

The increasing proportion of elderly people with teeth presents substantial and growing challenges for social care providers and dental health care providers, in terms of having to provide both specialist care and high quality daily dental hygiene measures to this population. The increasing proportion of elderly people with dementia who have teeth also heightens problems with challenging behaviour in this group of individuals and the difficulty in ensuring good dental health practice within residential care.



• Children’s Update Local conference ‘Our Children Deserve better Prevention Pays’ 20th June 2014 A local conference, hosted by Public Health was held on 20th June at Customs House South Tyneside to share the key findings and recommendations from the Chief medical Officers annual report published 2013. The welcoming address was delivered by Leader of the Council Ian Malcolm and was opened with a ‘YouTube’ link to Dame Professor Sally C Davies: Chief Medical Officer. Over 90 delegates attended from a range of services / organisations e.g. CCG, LA, Education, Voluntary sector. Presentations related to local health priorities for our children and young people, early years, childhood obesity, child development programme in South Tyneside and resilience with question time being led by Dr David Hambleton Chief Officer, South Tyneside CCG

The Chief Medical Officer’s (CMO) annual report published 2013 was written in response to the challenges to the health and wellbeing of our children and young people, particularly on whether we are all giving them a good start in life and building their resilience.

The report also looks at the evidence using a life course approach, the business case for investing in the health of children and young people, and the views of young people and their families and the challenges that we face. A number of recommendations are included in the document which broadly falls into three types:

• The voice of children and young people

• Building services and joining services

• The economic case for a shift to prevention

Mental Health and Emotional Wellbeing Strategy

A South Tyneside Mental Health and Emotional Wellbeing Strategy for children and young people has recently been recently been developed with a range of partners, including CCG, which looks at work across all 4 tiers, from universal to specialist services.



The Strategy has been presented to Health and Wellbeing Board, Children Adults and Families Board and People Select Committee for scrutiny (LA) and a local partnership action plan is currently being developed The CCG are lead commissioners for commissioning mental health services for children and young people via NTW. Flu Pilot: Primary School Children A pilot of nasal flu vaccination in primary school children was undertaken in Gateshead schools last year. The pilot was successful with overall uptake of 52.3% of all primary school aged children in Gateshead. This year the pilot is being extended to cover all primary schools in Gateshead, South Tyneside and Sunderland. Fluenz Tetra will be offered to all children in school years Reception to Year 6 in the autumn term of 2014/15 academic year. Fluenz Tetra is a flu vaccine administered as a nasal spray and has been shown to be highly safe and effective in children and acceptable to them. Building on experience in Gateshead and nationally, the pilot this year will use a classroom based model for administration of the vaccine by the School Nursing Service, South Tyneside Hospital NHS FT. The steering group is chaired by Public Health England. The Local Authorities are represented by members of their Public Health teams and communications teams. The pilot is funded by NHS England.

• Change4Life

The specification for the delivery of Change4Life central co-ordination unit (CCU) is currently being finalised and the procurement process will commence on the 31st July with a market event to engage potential providers in the process. The procurement will consist of 4 lots which can be tendered for separately or in combination with collaboration between partners.

The lots are

• Central Business Management • Training • Social marketing and • Coaching



It is anticipated that contracts will be awarded in October 2014 ensuring sufficient time for mobilisation with the new service to be fully operational April 2014

• Pioneer: Transformation and integration for health and social care

in South Tyneside – An innovative new approach to early help, self-care and integrated support services

People in South Tyneside are going to have the opportunity to benefit from a range of support to help them look after themselves more effectively, live more independently and make changes in their lives earlier.

Integration in South Tyneside is about changing and breaking down organisational barriers and bringing about a real culture shift to give people the knowledge, skills and confidence to be able to look after themselves more effectively. Our integration vision “I can promote my own health and wellbeing by planning my care and support with people who work together to understand me and my carers, allow me control and bring together services to achieve the outcomes important to me” Our integration principles

• We will impose a person perspective throughout our work • We will manage the organizational consequences of being person-

centered • Our staff will not automatically reach for traditional solutions • We will provide learning and development for our staff jointly, not

separately

Self-Care: The conversation starts it; the environment supports it The self-care offer attempts to make sure that the environment in South Tyneside supports and rewards self-care. Therefore, when a care professional empowers and activates a person to self-care, the environment supports and rewards the person so they continue to self-care. Mapping of target audience and training requirement have been undertaken and tested and the first Hebburn ‘Scene Setting’ workshop took place on



Thursday 26th June and was well attended with a mix of staff from partner organisations and representation from patients and pubic. An expression of interest to deliver the training programme has been developed and following award of contract a schedule of training will be rolled out across South Tyneside.

3. Health and Wellbeing Board Update Health and Social Care Integration – Update on the Better Care Fund Integrated Teams, C4L and Pioneer The South Tyneside Health and Social Care Integration vision has been developed by the Integration Board and is currently being tested with stakeholders. Dental Health in South Tyneside The Board agreed to support working towards the priorities identified within the LSCB Business Plan for 2014-17 and agreed work with the LSCB in developing and interpreting the JSNA with respect to safeguarding and promoting the welfare of children in South Tyneside. Performance Update – Smoking During Pregnancy 28.9% of women resident in South Tyneside who gave birth during the third quarter of 2013/14 described themselves as smokers at the time of the birth. This is higher than the NE average (16.3%), and more than double the national average (12.0%). The “Smoking in Pregnancy Pathway‟ for South Tyneside was re-launched in May 2013. The effect of this change will not be seen until data for Quarter 4 2013/14 is released, which is due next month. Local Quality Surveillance Group Update The Board received a presentational update from Age UK on the ongoing work of the Local quality Surveillance Group. Health and Wellbeing Board Governance – Links to LSCB The Board received a report summarising the key aspects of the proposed protocol between the Health and Wellbeing Board and the Local Children Safeguarding Board. The aim of the protocol is to support both partnerships to operate effectively, being clear about their respective functions, interrelationships and roles and responsibilities of all those involved in keeping children safe



Urgent Care Hub Dr David Hambleton, Chief Officer, STCCG gave a verbal update on the Urgent Care Hub. Mental Capacity Act/Deprivation of Liberty Helen Watson, Corporate Director Children, Adults and Families gave a verbal update on the Mental Capacity Act/Deprivation of Liberty

4. Recommendations

That the board accept the report






REPORT TITLE: CCG Assurance – Quarter 4 (Q4)/End of year



Name/Title: David Hambleton, Chief Officer South Tyneside Clinical Commissioning Group Tel/E-mail: 0191 283 1903 [email protected]

REPORT AUTHOR: Name/Title: Christine Briggs, Director of Operations South Tyneside Clinical Commissioning Group Tel/E-mail: 0191 283 1903 [email protected]


Appended are key documents associated with STCCG’s Quarter 4 assurance review with NHS England. The following are appended: (1) Letter from NHS England to STCCG dated 30th June 2014 (2) Quarter 4 CCG Assurance Report The letter congratulates the CCG on a successful first year of Operating and draws on a number of key successes, as well as setting out the areas of risk on which the CCG is currently focused and for which mitigating actions are in place (e.g. cancer 62 day pathway, MRSA/CDIFF, finances). The Assurance Report gives the CCG’s detailed position around the CCG assurance domains, each domain having been rated as “assured”. The report also sets out key activities underway including a high level risk analysis and mitigating actions, all of which the Governing Body are familiar with via internal in year reporting mechanisms.


Each of the domains was rated as ‘Assured’ and it was agreed to keep a watching brief for Domain 3 with regards to finance


NO YES

If no please specify the reason why: The CCG Assurance Framework is a national framework and would have been subject to a national equality impact assessment prior to its release.





For Information



High quality care for all, now and for future generations

Dear David, CCG Annual Assurance

Many thanks for meeting with the Area Team on 22nd

May 2014 to reflect on the

CCG’s first year of operation, to celebrate your achievements and agree the

CCG’s development priorities for 2014/15. This letter reflects at a high level, a

summary of the issues discussed in our quarterly assurance meetings throughout

the year and provides a summary of the CCG’s planned ambition and areas for

ongoing development. I am grateful to you and your team for the time and effort

put into preparing and taking part in the meetings and for the open and

transparent nature of our discussions which have led to productive conversations

throughout the year.

Key Areas of Strength / Areas of Good Practice

Your presentation gave an excellent overview of the breadth of activities

undertaken during the year and reflects clear strengths and innovation in relation

to quality and safety, transformation of care, partnership working and

engagement. We would like to acknowledge the good progress the CCG has

made in establishing the organisation as a leader in the local health and social

care economy and for embracing the local agenda and challenges. There is good

evidence of strong CCG leadership and maturing relationships with key strategic

Cumbria, Northumberland, Tyne and Wear

Area Team Waterfront 4

Newburn Riverside Newcastle upon Tyne

NE15 8NY

30 June 2014

David Hambleton Accountable Officer NHS South Tyneside CCG Monkton Hall Monkton Lane Jarrow NE32 5NN


partners, who are all signed up to a collective vision to improve the health

outcomes for local people in South Tyneside. It is positive to see the

collaborative relationships that are developing with both local government and

providers as evidenced through the successful Integrated Pioneer bid. The drive

for greater integrated working with partners, supported by the agreed

underpinning principles, places you in a strong position to address the financial

and service challenges in the coming year.

NHS Constitution Standards

We recognise there has been consistent strong delivery in relation to the majority

of NHS Constitution Standards throughout the year, and appreciate that when

there have been pressures, that these have been actively addressed by the CCG

and shared with the Area Team in an proactive and transparent manner. Areas

of underperformance include HCAI, cancer 62 days standard and the Friends

and Family test which will require proactive dialogue with providers to ensure

sustained delivery.

NHS Statutory Duties

Throughout the year, it has been pleasing to see the local focus on improving the

quality and patient safety through joint working across the health system. The

development of the local QSG, improvement in incident reporting from South

Tyneside FT, and the work with the local authority to improve quality in care

homes are all excellent examples which has contributed to the improved position.

Similarly your proactive approach to patient and public involvement has

demonstrated impact on the development and delivery of plans throughout the

year. Of particular interest is the engagement programme you have with local

schools on the importance of health and wellbeing.

You confirmed that the CCG was on course to complete the 2013/14 CCG

Annual Report in the required timescale.

Key Areas of Challenge

Although the CCG achieved financial balance this year, we recognised the

challenges going forward including ongoing continuing healthcare costs and the


need to deliver savings in acute sector as required by the Better Care Fund. The

latter will bring with it other challenges such as the transformation of the

workforce and we look to work with Higher Education England North East to

facilitate the changing skill mix and ways of working required.

A further key challenge will be your ability to create the capacity in the system to

deliver your planned changes and it was good to hear of your focused approach

to maintaining a manageable number of priorities. It will be important for you to

engage fully with NECs to maximise their contribution as a support organisation

to deliver change.

Key Interdependencies and Associated Issues

Your Strategic Plan sets out a clear vision, level of ambition and high level

priorities for change. We note the longer timescale with regard to the

development of the national strategies for both primary care and specialist

commissioned services and the impact locally. You noted intent to jointly

progress the primary care agenda in order to support the transformation of

services over the next 5 years. We will continue to explore with you any

additional support that you may need to deliver the ambitious programme you

have set.

Development Needs and Agreed Actions

You updated on the breadth of progress with organisational development in the

CCG, whilst this has been positive, you recognised the need to continue efforts

to maintain current good relationships with member practices to ensure delivery

of your plans. We are delighted that you have taken the opportunity to increase

capability for transformational change with support from NHS IQ with a

programme focussed on integrated working.

Assurance Framework

We reflected on the evidence and agreed the Headline Assessment of ‘Assured’

overall. Each of the six domains was rated as ‘Assured’ and we agreed a

watching brief for Domain 3 with regards to finance.

Summary


In summary, we would like to congratulate you on the excellent progress you

have achieved in your first year as a statutory body. 2014/15 will be a challenging

year for all CCGs, but we consider that you are well placed to address the

challenges given the progress achieved in your first year.

I hope this letter provides an accurate summary of our discussions and notes the

areas for ongoing development going forward. We look forward to continuing to

work with you as co commissioners to improve the health and wellbeing of the

residents of South Tyneside.

With best wishes for a successful 2014/15.

Yours sincerely

Alison Slater Director of Operations and Delivery Cumbria, Northumberland, Tyne and Wear Area Team NHS England

Cc Dr Matthew Walmsley

NHS South Tyneside CCG for Q4 Assurance - 22 May 2014

Headline Assessment – Assured

Focus Assurance level

Particular achievements noted / examples of good practice Issues identified

Any issues identified requiring further action and actions agreed

Are patients receiving clinically commissioned, high quality service?

Assured 1. Development programme for member practices (monthly education forum/CoP meetings) includes a quality focus: Safeguarding, (Oct 13/Jan 14) Francis report (June 2013,) quality & CQUIN ( June), Winterbourne View (Oct 2013)

2. Joint HCAI Group across Sunderland and South Tyneside CCG areas with clear systems, processes & action plans

3. Audit carried out by best practice organisation (Bassetlaw NHS Trust), to review local action plans against theirs, no gaps identified in local processes

4. CDI Card (held by staff on wards) Guidance for the management of patient with unexplained diarrhoea

5. Detailed Governing Body focus on quality issues via Quality, Patient Safety & Risk Committee, with each meeting starting with a live patient story

6. South Tyneside Improving Care Scheme (STICS) – planned approach in caring for vulnerable/housebound/ seldom seen patients via general practice COPD registers & associated increase in referrals to pulmonary rehab service

7. Clinically led “deep dive approach” to cancer 62 day pathway issues working in partnership with STFT

8. Continued work around implementation of incident reporting systems for primary care

From Dashboard: 62 day cancer pathway referral from NHS Screening service MRSA and CDIFF – over target

4 out of 5 patients seen; 1 patient declined 1st investigation offer and DNA’d 2nd. Joint HCAI Group across Sunderland and South Tyneside CCG areas with clear systems, processes & action plans Audit carried out by best practice organisation (Bassetlaw NHS Trust), to review local action plans against theirs, no gaps identified in local processes CDI Card (held by staff on wards) Guidance for the management of patient with unexplained diarrhoea Taking part in regional level work to address HCAI

Are patients and the public actively engaged and involved?

Assured 1. Developed the Community Involvement Steering Group, the engagement arm of HWB – further development in year

2. Leadership and delivery of local engagement board sessions and other methods of engaging public/patients including Call to Action & Planning, Commissioning Intentions, specific Mental Health service reform consultative events.

3. Presentations to People Select Committee and Overview and Scrutiny throughout the year on key issues including planning, development of commissioning intentions, winter pressures.

4. Presentations to Community Area Fora throughout the year on

No issues identified.

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key issues including planning, development of commissioning intentions

5. Over 25 patient stories on records, themes logged and actions taken

6. Use of social media and website for engagement with wider audience

7. 1st year of Patient Reference Group (group made up of patient reps from practice for a in the borough) and chaired by CCG lay member

8. Patient champions engaged in integration pioneer work around self care

9. Altogether Better Scheme being implemented with practices (community champions)

Are CCG plans delivering better outcomes for patients?

Assured 1. 5 year plan with 2 year operating level detail, being developed to NHS Planning Framework requirements – partially delivered to date in accordance with deadlines

2. Public Health Support continues to be a key feature in our planning – we have identified specific workstreams around CVD, Cancer and Respiratory

3. Involvement of member practices in prioritising for planning round 4. Work specifically includes the Commissioning for Value pack and

other toolkits available as part of this year’s planning round. 5. The financial position in South Tyneside has been difficult

through 2013-14, with the CCG not able to meet all its financial planning guidelines, but has demonstrated the ability to broadly manage to the financial plan set, has absorbed a number of one off issues in the process and delivered a small surplus. The position in 2014-15 is expected to be similar but improving and then in 2015/16 reaching a more stable position where the planning requirements will be met.

2011 data on dashboard illustrates CCG as outlier in relation to preventing people dying prematurely.

Plans to engage communities at ward level, work to be based around the specific features of each ward and engagement to be tailored accordingly GP scheme for 14/15 to take in CVD/cancer/respiratory (work in progress, may focus on cancer rather than all 3 areas – TBC) Work on 5 year plan also refers

Does the CCG have robust governance arrangements?

Assured 1. Committee structures fully established as at 1st April 2014 2. Governing Body Development sessions have taken place across

the year, e.g. board to boards with STFT; development of compact; equality & diversity

3. Review of Governing Body effectiveness underway at time of writing


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4. Board Assurance Framework in place 5. Governance work plan in place

Are CCGs working in partnership with other?

Assured Development of working partnerships and strong and sustainable relationships with:

Health and Wellbeing Boards (HWB) Integration Board which includes Council and key health providers & other partners from across the borough North of England Commissioning Support Unit (NECS) Other CCGs locally Cumbria, Northumberland and Tyne & Wear Area Team Local communities Community and voluntary sector


Does the CCG have strong and robust leadership?

Assured 1. Leadership capability and culture developed through all the engagement work with member practices and council of practices including embedding the Compact

2. Regular monthly board development sessions for Governing Body which addresses leadership/team development needs.

3. Regular time for executive to build leadership capability – e.g. NELA and other local/national providers

4. Joint leadership of HWB development sessions and Integration Board

Going forward we will Continue to develop leaders & leadership teams who

demonstrate commitment to partnership working & have necessary skills to lead commissioning/drive transformational change including:

Governing Body; Executive team; Council of Practices

Member practices, including Practice Managers, GPs and Nurses

System wide leadership via integration board Establish mechanisms for succession planning in the CCG To develop the culture in accordance with vision and values


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Audit and Risk Committee

Terms of Reference

1. Introduction

1.1 The Audit and Risk Committee (the Committee) is established in accordance with NHS South Tyneside Clinical Commissioning Group’s Constitution. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and shall have effect as if incorporated into the Constitution.

1.2 The Committee will provide the Governing Body with an independent

and objective review on their financial systems, financial information and compliance with laws, guidance, and regulations governing the NHS in so far as they relate to finance. The Committee is a non-executive committee of the Board. It has no executive powers, other than those specifically delegated to it and as set out in these Terms of Reference.

1.3 In establishing the Committee and preparing these Terms of

Reference, specific regard has been had to the guidance contained within the NHS Audit Committee Handbook, NHS Codes of Conduct and Accountability and the Higgs Report.

2. Membership

2.1 The Committee shall be appointed by the Clinical Commissioning Group (CCG) as set out in the Clinical Commissioning Group’s Constitution and may include individuals who are not on the governing body.

2.2 The Committee shall consist of a Chair, who will be a lay member of

the Governing Body with a lead role in overseeing key elements of governance, together with two other members, at least one of whom will be a lay member of the Governing Body. The third member shall be appointed by the Governing Body and shall be a non Governing Body lay member with the appropriate skills or experience to be able to make a contribution to the Audit and Risk Committee.

2.3 The membership of the Committee will comply with provisions set out

in regulations and within the CCG’s Constitution and associated Standing Orders.

2.4 The Chair of the Governing Body will not be a member of the

Committee.

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3. Attendance

3.1 The Chief Finance Officer and appropriate Internal and External Audit representatives shall normally attend meetings. At least once a year the Committee should meet privately with the Internal and External Auditors.

3.2 Regardless of these usual arrangements for attendance, external audit,

internal audit, local counter fraud and security management (NHS Protect) will have full and unrestricted rights of access to the Audit and Risk Committee.

3.3 The Chief Officer and other executive directors should be invited to

attend, particularly when the Committee is discussing areas of risk or operation that are the responsibility of that director.

3.4 The Chief Officer should be invited to attend and should discuss at

least annually with the Committee the process for assurance that supports the Annual Governance Statement. He/she should also attend when the Committee considers the draft internal audit plan and the annual accounts.

3.5 The Chair of the Governing Body may also be invited to attend one

meeting each year in order to form a view on, and understanding of, the Committee’s operations.

4. Secretary

4.1 The Company Secretary shall be Secretary to the Committee and shall ensure that a minute of the meeting is taken and provide appropriate support to the Chair and Committee members.

5. Quoracy and Decision making

5.1 The quorum shall be two members of the Committee.

5.2 In the event of the Chair of the Committee being unable to attend all or part of the meeting, he /she will nominate a replacement from within the membership to deputise for that meeting.

5.3 Generally it is expected that decisions will be reached by consensus.

Should this not be possible then a vote of members will be required. In the case of an equal vote, the person presiding (i.e. the Chair of the meeting) will have a second, and casting vote.

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6. Frequency and notice of meetings

6.1 Meetings of the Committee shall be held not less than four times a year. The External Auditor or Head of Internal Audit may request a meeting if they consider that one is necessary.

6.2 The Committee may also hold a number of informal meetings during

the year. 7. Authority

7.1 The Committee is authorised by the Governing Body to pursue any activity within these Terms of Reference and within the Scheme of Reservation and Delegation, including (without limiting the generality of the foregoing) to:

a) seek any information it requires from CCG employees, in line with

its responsibility under these terms of reference and the Scheme of Reservation and Delegation

b) require all CCG employees to co-operate with any reasonable

request made by the Committee, in line with its responsibility under these terms of reference and the Scheme of Reservation and Delegation

c) review and instigate an investigation of any matter within its remit

and grants freedom of access to the CCG’s records, documentation and employees. The Committee must have due regard to the Information Governance Policies of the organisation regarding personal identifiable information and the organisation’s duty of care to its employees when exercising its authority

d) obtain outside legal or other independent advice and to secure the

attendance of persons with relevant experience and expertise if it considers this necessary

e) set up any joint working arrangements with other bodies

f) establish sub-committees to deliver its objectives.

7.2 In exercising its authority, the Committee is required to comply with:

a) the CCG’s Standing Orders and Standing Financial Instructions

b) the CCG’s Standards of Business Conduct and Declaration of

Interests Policy

c) the section of the Scheme of Delegation which refers to this Committee


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8. Remit and responsibilities of the Committee

8.1 Overall responsibility

8.1.1 The Committee shall critically review the clinical commissioning group’s financial reporting and internal control principles and ensure an appropriate relationship with both internal and external auditors is maintained.

8.2 Governance, Risk Management and Internal Control

8.2.1 The Committee shall review the establishment and maintenance

of an effective system of integrated governance, risk management and internal control, across the whole of the organisation’s activities (both clinical and non-clinical), that supports the achievement of the organisation’s objectives.

8.2.2 In particular, the Committee will review the adequacy and

effectiveness of:

• all risk and control related disclosure statements (in particular the Annual Governance Statement where this is required), together with any accompanying Head of Internal Audit statement, external audit opinion or other appropriate independent assurances, prior to endorsement by the CCG’s Governing Body;

• the underlying assurance processes that indicate the degree of the achievement of corporate objectives, the effectiveness of the management of principal risks and the appropriateness of the above disclosure statements;

• the Board Assurance Framework, using it operationally to guide the work of the Committee in identifying and gaining assurances on the key risks to the CCG’s achievement of its strategic objectives

• the Corporate Risk Register and scrutiny of the internal controls and actions for extreme and high level risks

• systems for the identification, evaluation and prioritisation of risks including financial risk and QIPP, health and safety, emergency preparedness, business continuity, information governance, equality and diversity and sustainable development

• the policies for ensuring compliance with relevant regulatory, legal and code of conduct requirements and related reporting and self-certification;

• the policies and procedures for all work related to fraud and corruption as set out in Secretary of State Directions and as required by the Counter Fraud and Security Management Service (now known as NHS Protect):


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• the CCG’s arrangements for effective management of all matters relating to contractual performance and associated financial performance

8.2.3 In carrying out this work the Committee will primarily utilise the

work of Internal Audit, External Audit and other assurance functions, but will not be limited to these sources. It will also seek reports and assurances from directors and managers as appropriate, concentrating on the over-arching systems of integrated governance, risk management and internal control, together with indicators of their effectiveness.

8.2.4 This will be evidenced through the Committee’s use of an

effective Assurance Framework to guide its work and that of the audit and assurance functions that report to it.

8.2.5 The Committee will ensure that there are robust controls in

place for the management of conflicts of interest.

8.3 Internal Audit

8.3.1 The Committee shall ensure that there is an effective internal audit function that meets mandatory NHS Internal Audit Standards and provides appropriate independent assurance to the Audit and Risk Committee, Accountable Officer and the governing body. This will be achieved by:

• consideration of the provision of the Internal Audit service,

the cost of the audit and any questions of resignation and dismissal;

• review and approval of the Internal Audit strategy, operational plan and more detailed programme of work, ensuring that this is consistent with the audit needs of the organisation as identified in the Assurance Framework;

• considering the major findings of internal audit work (and management’s response), and seeking to ensure co-ordination between the Internal and External Auditors to optimise audit resources;

• ensuring that the Internal Audit function is adequately resourced and has appropriate standing within the organisation;

• annual review of the effectiveness of internal audit.


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8.4 External Audit

8.4.1 The Committee shall review the work and findings of the external auditors and consider the implications and management’s responses to their work. This will be achieved by:

• consideration of the appointment and performance of the

external auditors, as far as the rules governing the appointment permit;

• discussion and agreement with the external audit before the audit commences, of the nature and scope of the audit as set out in the Annual Plan, and seeking to ensure coordination, as appropriate, with other external auditors in the local health economy;

• discussion with the external auditors of their local evaluation of audit risks and assessment of the CCG and associated impact on the audit fee;

• review of all external audit reports, including the report to those charged with governance, agreement of the annual audit letter before submission to the Governing Body and any work undertaken outside the annual audit plan, together with the appropriateness of management responses.

8.5 Other Assurance Functions

8.5.1 The Audit and Risk Committee shall review the findings of other

significant assurance functions, both internal and external to the organisation and consider the implications for the governance of the organisation.

8.5.2 These will include, but will not be limited to, any reviews by

Department of Health Arms Length Bodies or Regulators/Inspectors (for example, the Care Quality Commission, NHS Litigation Authority etc.) and professional bodies with responsibility for professional standards, performance and advice (e.g., Royal Colleges, accreditation bodies, etc.)

8.5.3 In addition, the Committee will review the work of other

committees within the organisation, whose work can provide relevant assurance to the Audit and Risk Committee’s own scope of work.

8.6 Counter Fraud

8.6.1 The Committee shall satisfy itself that the organisation has

adequate arrangements in place for countering fraud and shall review the outcomes of counter fraud work.


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8.7 Management

8.7.1 The Committee shall request and review reports and positive assurances from the senior managers of the CCG on the overall arrangements for governance, risk management and internal control.

8.7.2 They may also request specific reports from individual functions

within the organisation as they may be appropriate to the overall arrangements.

8.8 Financial Reporting

8.8.1 The Audit and Risk Committee shall monitor the integrity of the

financial statements of the Trust and any formal announcements relating to the CCG’s financial performance.

8.8.2 The Committee should ensure that the systems for financial

reporting to the Governing Body, including those of budgetary control, are subject to review as to completeness and accuracy of the information provided to the governing body.

8.8.3 The Audit and Risk Committee shall review the Annual Report

and Financial Statements before submission to the Governing Body, focusing particularly on:

• the wording in the Annual Governance Statement and other

disclosures relevant to the Terms of Reference of the Committee;

• changes in, and compliance with, accounting policies and practices and estimation techniques;

• unadjusted misstatements in the financial statements; • significant judgments in preparation of the financial

statements; • significant adjustments resulting from the audit. • letter of representation • qualitative aspects of financial reporting.

9. Reporting Arrangements

9.1 The minutes of Audit and Risk Committee meetings shall be formally recorded and submitted to the Governing Body.

9.2 The Chair of the Committee shall draw to the attention of the

Governing Body any issues that require disclosure to the Governing Body, or require executive action.


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9.3 The Committee will report to the governing body at least annually on its work in support of the Annual Governance Statement, specifically commenting on the fitness for purpose of the Assurance Framework, the completeness and ‘embeddedness’ of risk management in the organisation and the integration of governance arrangements. In making this report to the Governing Body the Committee will draw on a self-assessment of its performance and effectiveness during the year.

10. Conduct of the Committee

10.1 All members of the Committee and participants in its meetings will comply with the Standards of Business Conduct for NHS Staff, the NHS Code of Conduct, and the CCG’s Policy on Standards of Business Conduct and Declarations Interest which incorporates the Nolan Principles.

11. Date of Review

11.1 The Committee will review its own performance, membership and Terms of Reference annually. Recommendations for amendment of the Terms of Reference will be made to the CCG’s Governing Body for approval.


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Quality and Patient Safety Committee

Terms of Reference 1. Introduction

1.1 The Quality and Patient Safety Committee (the Committee) is established as a committee of the Governing Body of the Clinical Commissioning Group, in accordance with constitution, standing orders and scheme of delegation.

1.2 These terms of reference set out the membership, remit,

responsibilities and reporting arrangements of the committee and shall have effect as if incorporated into the CCG Constitution and Standing Orders.

2. Principal Function

2.1 The Quality and Patient Safety Committee is responsible for ensuring the appropriate governance systems and processes are in place to:

• Commission, monitor and ensure the delivery of high quality, safe

patient care in commissioned services, • facilitate, monitor and ensure quality improvement in general

medical practice working with NHS England.

2.2 In achieving this, the Committee will seek to promote a culture of continuous improvement and innovation with respect to safety of services, clinical effectiveness and patient experience, to secure public involvement, to promote research and the use of research and to provide assurance to the Governing Body about the quality, safety and patient safety-related risks of the services being commissioned and the impact of those risks on the organisation’s strategic and operational plans.

2.3 The Committee will, as delegated by the Governing Body, provide

oversight and scrutiny of arrangements for supporting NHS England in relation to securing continuous improvement in the quality of primary medical services.

2.4 The Committee will, as delegated by the Governing Body, approve

arrangements for handling complaints, information governance including arrangements for handling Freedom of Information requests.

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3. Accountability

3.1 The Quality and Patient Safety Committee is a Committee of the CCG’s Governing Body.

4. Membership

4.1 Membership of the Committee will include:

Executive members:

CCG Chairman Lay Member – Committee Chair Lay Member (for patient and public involvement) Governing Body GP member Director of Nursing, Quality & Safety Secondary Care Specialist Doctor Chief Officer

Associate members:

Head of Safeguarding Head of Quality Director of Operations North of England Commissioning Support Clinical Directors – as appropriate CCG GP Medicines Management Lead Prescribing Adviser Locality Cancer Network Chair

4.2 The Chair has the responsibility to ensure that the Committee obtains

appropriate advice in the exercise of its functions. Officers, employees, and practice representatives of the CCGs and other appropriate individuals may be invited to attend all or part of meetings of the Committee to provide advice or support particular discussion from time to time.

5. Authority

5.1 The Governing Body authorises the Committee to pursue any activity within these Terms of Reference including to:

(i) Seek any information it requires from CCG employees, in line

with its responsibility under these terms of reference and the Scheme of Reservation and Delegation;

(ii) Require all CCG employees to co-operate with any reasonable

request made by the Committee, in line with its responsibility under these terms of reference and the Scheme of Reservation and Delegation;

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(iii) Review and investigate any matter within its remit and grant freedom of access to the organisation’s records, documentation and employees. The Committee must have due regard to the policies of the CCG, regarding personal health information and the CCG’s duty of care to its employees when exercising its authority.

5.2 In discharging its responsibilities the Committee will comply with the

CCG’s Standing Orders and Prime Financial Policies and Standards of Business Conduct and Declarations of Interest Policy.

5.3 The Committee is authorised to establish sub-committees to assist it in

discharging its responsibilities. Such sub-committees will include the Infection Control Performance and Practice Committee and the Safeguarding Strategic Group, both of which will be established as joint arrangements with other CCGs. The Medicines Management Committee is also a sub-committee of the Committee.

6. Roles and Responsibilities

6.1 Quality in Commissioned Services

6.1.1 To develop, monitor and review the CCG’s vision and framework for commissioning services which are high quality, safe, clinically effective and which provide positive patient/carer experience.

6.1.2 To receive reports on the quality of commissioned services, to

review patient safety-related risks arising and monitor progress in implementing recommendations and action plans.

6.1.3 Where the CCG is the coordinating commissioner ensure

provision of appropriate, quality assurance and improvement information to collaborating CCGs; in particular escalating any areas of concern in a timely way.

6.1.4 To receive reports on the quality of commissioned services from

other CCGs where they act as the coordinating commissioner and the CCG has contracts.

6.1.5 To receive annual reports from the sub-committees of the

Committee as specified at 5.3.

6.1.6 To seek assurance on the performance of NHS provider organisations in terms of the Care Quality Commission, Monitor and any other regulatory bodies. (Note that the Monitor’s compliance framework relies on assurance from third parties, including local commissioners of services).


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6.1.7 To receive and review the draft Quality Accounts of NHS providers where the CCG acts as coordinating commissioner and approve the corroborative statement to the provider within the timescales outlined in the Quality Account Regulations.

6.1.8 To receive and review the published Quality Accounts of NHS

Foundation Trusts which, as a minimum, will include those relating to the Foundation Trusts which provide local acute services, community health care services and mental health and learning disabilities services to the South Tyneside population.

6.1.9 To oversee the development of quality incentive schemes e.g.

CQUIN ensuring alignment to CCG strategic priorities and national requirements.

6.1.10 To ensure a clear escalation process, including appropriate

trigger points, is in place to enable appropriate engagement of external bodies in relation to areas of concern, with a view to an external review being carried out.

6.1.11 To ensure appropriate collaboration with the Local Area Team of

NHS England e.g. through future Local Area Quality Surveillance Group.

6.1.12 To review the Committee’s effectiveness on an annual basis and

produce a report on the findings for the Governing Body.

6.2 Improving Quality in General Medical Practice

6.2.1 To ensure that agreements and processes in place with the group’s members to secure improvements in the quality of primary medical services in terms of clinical effectiveness, patient safety and patient experience in GP practices.

6.2.2 To ensure an appropriate interface and collaborative working

with NHS England is maintained in relation to quality in general medical practice.

6.3 Patient Safety – overarching systems

6.3.1 To receive reports on clinical risks, incident reporting, serious

incidents, ‘Never Events’, complaints, claims and safety alerts; and monitor progress in implementing recommendations and action plans.

6.3.2 To ensure the development or adaptation of a Patient Safety

Assurance Framework with systems for monitoring quality and safety of care, with reference to a range of indicators which might include Care Quality Commission ratings and reviews, Monitor ratings and any other relevant sources of external assurance.


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6.3.3 To receive and scrutinise independent investigation reports

relating to patient safety issues and agree publication plans.

6.3.4 To receive reports on the management of infection control performance, especially health care acquired infections.

6.3.5 To receive assurance in relation to Medicines Management,

including information about safety alerts not less than annually.

6.3.6 To assist NHS England in work relating to controlled drugs and receive reports as appropriate.

6.3.7 To receive minutes from the Medicines Management Committee

6.3.8 To ensure that appropriate strategies and training plans are in

place for safeguarding of children and vulnerable adults, receiving appropriate reports pertaining to the CCG’s safeguarding duties.

6.4 Patient Experience

6.4.1 To ensure that the views of patients and the public are properly

reflected in the development and implementation of CCG Policies and Plans and to receive and act upon reports regarding patient experience.

6.4.2 To oversee the development and implementation of a structured

and planned approach to the collection and use of patient reported experience in both provider management processes and commissioning decisions. To ensure that this approach includes use of feedback from individual consultations in practice. To ensure that the CCG can demonstrate that patient feedback has been used in commissioning decisions.

6.5 Clinical Effectiveness

6.5.1 To promote and encourage an evidence based culture within the

CCG and wider health economy ensuring that CCG commissioning takes account of national guidance such as NICE guidance including technology appraisal guidance, NICE quality standards and other relevant standards e.g. from Royal Colleges and professional bodies.

6.5.2 To ensure that the CCG promotes research and the use of

research.


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6.6 Risk

6.6.1 To ensure that all systems are in place and operating effectively for the identification, assessment and prioritisation of potential clinical quality and patient safety-related risk and to report on any major strategic issues.

6.7 General

6.7.1 To consider and approve relevant policies and procedures as

appropriate on behalf of the governing body. This duty may be delegated to sub-committees or executive arrangements.

7. Administration

7.1 The Governing Body Secretary will ensure that a minute of the meeting is taken and provide appropriate support to the Chair and Committee members.

8. Quorum

8.1 The quorum shall be one third of the membership of the Committee, including at least one Lay member and one clinical executive member (doctor or nurse).

9. Decision Making

9.1 Generally it is expected that decisions will be reached by consensus. Should this not be possible then a view of members will be required. In the case of an equal vote, the person presiding (i.e. the Chair of the meeting) will have a second, and casting vote.

10. Frequency and Notice of Meetings

10.1 Meetings will be held as frequently as the Chair shall judge necessary to discharge the responsibilities of the Committee, but shall be at least six times per year.

11. Attendance at Meetings

11.1 The members of the Committee are required to provide information to progress and inform the agreed agenda items.

11.2 The Committee members are required to attend each meeting or if

apologies are made any information they are expected to contribute must be supported either through a deputy or in writing to the Chair.

11.3 In addition to the core membership the Committee may co-opt

additional members as appropriate to enable it to undertake its role.


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12. Reporting Arrangements

12.1 The minutes of the meetings shall be formally recorded and submitted to the Governing Body.

12.2 The Chair of the Committee shall draw to the attention of the

Governing Body any issues that require disclosure to the Governing Body, or require executive action. The Committee will report to the Governing Body at least annually on its work.

13. Policy and best practice

13.1 The Committee will apply best practice in its decision making, and in particular it will:

• ensure that decisions are based on clear and transparent criteria • comply with CCG policy and procedures for the declaration of

interests

13.2 The Committee will have full authority to commission any reports or surveys it deems necessary to help it fulfil its obligations and to invite individuals to attend as appropriate to provide advice on its functions.

14. Conduct of the Committee

14.1 All members of the Committee and participants in its meetings will comply with the Standards of Business Conduct for NHS Staff, the NHS Code of Conduct and the CCG’s Policy on Standards of Business Conduct and Declarations of Interest which incorporate the Nolan Principles.

15. Date of Review

15.1 The committee will review its performance, membership and these Terms of Reference at least once per financial year. It will make recommendations for any resulting changes to these Terms of Reference to the Governing Body for approval.

15.2 No changes to these Terms of Reference will be effective unless and

until they are agreed by the Governing Body.


Serving the healthcare needs of South Tyneside

Annual report and accounts2013-14

2 Serving the healthcare needs of South Tyneside 3

South Tyneside Clinical Commissioning Group

3

Annual report and accounts 2013-14

Member Practices’ introduction 4

Strategic report 6

About us 6

Our vision 7

Challenges and priorities 7

Engagement and partnership working 8

Improving performance integration and partnerships 9

An integrated South Tyneside 10

Improving performance 14

The year in focus 18

Engagement for better services 20

Promoting good health 20

Sustainability and the environment 21

Equality and diversity 22

Members report 24

Details of members of the Membership Body and Governing body 24

Council of Practices membership 25

Pension liabilities 27

Sickness absence data 27

External audit 28

Disclosure of serious untoward incidents 28

Cost allocation and setting of charges for information 28

Principles for remedy 28

Employee consultation 29

Disabled employees 29

Emergency preparedness, resilience and response 29

Statement as disclosure to auditors 29

Remuneration report 30

Remuneration committee 30

Membership Body and Governing Body profiles 37

Statement by the Accountable Officer 41

Statement of Accountable Officer’s responsibilities 41

Governance statement 42

Annual accounts 68

Contents



NHS South Tyneside Clinical Commissioning Group (CCG) is a clinically-led membership organisation made up of 28 general practices working alongside a range of other healthcare professionals, covering a local population of around 152,000.

In April 2013, we took over responsibility for planning and purchasing of local healthcare services on behalf of patients across the borough of South Tyneside.

Some of our first year was spent analysing the needs of the local population and assessing the challenges we face both locally and nationally. South Tyneside is one of the 20% most deprived local authorities in the country and there is also great inequality between the most and least affluent areas within the borough. We have lower life expectancy than the national average along with higher levels of poor mental health, alcohol consumption, smoking, obesity, cancer, respiratory and heart disease. There must therefore be significant changes in the way health services are commissioned and provided if we are to meet the needs of an ageing population successfully, as well as to reduce health inequalities and reduce early mortality; this is especially challenging in the current financial climate.

All 28 GP practices in South Tyneside are members of the CCG and have a role in developing plans for better local

healthcare. Working with patients on a daily basis gives us a unique insight into their needs. We also work very closely with the community and voluntary sector who provide expertise on the health challenges faced by local people. This hands-on consultative approach with our partners (e.g. local hospitals, local authorities, local community groups, etc.) ensures we can deliver a joined-up strategy resulting in high quality healthcare for all our South Tyneside communities.

A person-centred approach is at the heart of everything we do. As the CCG was formed by GPs and involves every practice in the borough, we are ideally placed to see the problems our patients encounter, and have a unique insight into how we can address those problems. Consultation and engagement with the local population and

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5


involvement of our patients, their carers, families and our community is central to the work of the CCG. Our patient stories and ‘Call to Action’ initiatives, our work in schools and links with local groups via the Local Engagement Board, our new Patient Reference Group, and HealthNet are a few examples of recent initiatives; our good relationship with local Healthwatch also supports our inclusive approach.

Collaborative working is also essential if we are to meet the healthcare and wider needs of the community. We have

worked closely with many organisations such as South Tyneside Council and NHS England as well as neighbouring CCGs, stakeholders and with organisations that provide hospital, community, voluntary and primary care services.

This approach gives us a very real chance of achieving our key objectives and building an NHS fit for the 21st century, one which provides high quality, innovative, safe and efficient healthcare for the people of South Tyneside.

The annual report reflects on our progress and performance throughout the year and gives details of the impact our members have had in key areas. The report also

includes information about how the Governing Body has evaluated

their performance; this information can be

found in the governance

statement.



The purpose of the strategic report is to both help inform and assess how we have performed over the last year.

CertificationWe certify that the clinical commissioning group has complied with the statutory duties laid down in the National Health Service Act 2006 (as amended).

Dr David Hambleton Accountable Officer

4 June 2014

About us

We were established and fully authorised as a statutory body on 1 April 2013 when the CCG took over responsibility for the planning and purchasing of local healthcare services on behalf of patients across the borough of South Tyneside. CCGs are the new NHS organisations that have acquired the majority of the commissioning role from former primary care trusts as a result of the changes described in the Health and Social Care Act 2012.

The CCG is responsible for planning and commissioning NHS healthcare to improve the health outcomes of local people in South Tyneside. We are made up of doctors, nurses and other health professionals, working alongside experienced healthcare managers.

Our health service responsibilities:

• Planned hospital care

• Urgent and emergency care

• Rehabilitation care

• Community health services

• Mental health and learning disability services

Strategic report

7


Our vision

Our vision is to work collaboratively across South Tyneside to improve health and to commission excellent healthcare. We do this by integrating health and social care services; improving the patient experience; and making the best use of resources.

Our five-year plan states that by 2016/17, we will have made the following positive changes to South Tyneside’s healthcare services:

• Improved health and wellbeing outcomes for local people, particularly reduced mortality from cancer, cardiovascular disease and respiratory disease together with a reduction in health inequalities across the locality

• Better integration of services across health and social care

• More effective clinical decision-making supported by shared decision-making techniques. Reduced unwarranted clinical variation, thereby generating increased efficiencies and ensuring value for money

• Improved quality of prescribing and thereby generating efficiencies and ensuring value for money

• Fewer admissions to hospital

Challenges and priorities

We have identified a number of key challenges facing South Tyneside. Compared to the rest of the UK, South Tyneside rates significantly worse on

most high level health measures, and is currently in the 20% of local authorities with the highest levels of deprivation. Life expectancy, on average, is eight years less than the rest of England with a gap of over ten years between the most deprived and least deprived areas in the borough.

The post-industrial legacy in South Tyneside and decline in mining economy over the past 50 years has brought with it a general decline in prosperity and an increase in deprivation, and we know that low income is directly linked with health inequalities and lower life expectancy. Other known high risk health factors include poor mental health, higher levels of smoking, drinking, obesity, cancer, respiratory and heart disease.

The current population of South Tyneside stands at 152,600 with a predicted 7% increase over the next 20 years. In line with the rest of the UK, the age structure of the population is also predicted to change. The working age population is likely to fall by 3%, and the number of people aged 65 and over will increase by 40%, and aged 85 and over by 70%. This ageing population will have a significant impact for the healthcare provision of the borough. Not only will there be an increased burden on the working population to provide care but the burden on health services, demand for hospital beds, longer hospital stays and complex health needs are also predicted.

The Joint Strategic Needs Assessment (JSNA) alongside partners including South Tyneside Council, the third sector and patient, carer and public groups identified the following commissioning priorities for



healthcare provision in South Tyneside:

• Provide the best start in life including better maternal health and promotion of healthy lifestyle

• Better health for adults and the elderly including the need to commission evidence-based interventions for cancer and CVD which address prevention and early treatment, increase uptake of NHS Health Checks and commission a range of services which address lifestyle factors including smoking, alcohol and obesity, focusing on targeted areas of the population

• Improve support for vulnerable people identifying older people at risk, reducing social isolation as well as focusing on an integrated approach to prevention and early intervention

• Reduce health inequalities by focusing on the wider social and economic determinants of health and by targeting areas where service uptake is low

Engagement and partnership working We work in partnership with local NHS Trusts as well as local voluntary sector organisations and community groups to identify the needs of the diverse local community we serve. We seek the views of patients, carers and the public through individual feedback/input, consultations, working with other organisations and community groups, attendance at community events and engagement activity

including patient surveys, focus groups and Healthwatch.

As the local commissioners of health services, we seek to ensure that our health services reflect the needs of the local population. We appreciate that to deliver this, it requires meaningful consultation, engagement and involvement of all our stakeholders. We aim to ensure that comments and feedback from our local communities are captured and, where possible, acted upon and give local people the opportunity to influence local health services on their terms and enable people to have their say using a variety of methods; from completing surveys to attending events and providing feedback either online, via post, text or telephone. We invite people to be involved as little or as much as they like, enabling them to help shape and influence the way NHS health services are commissioned.

In particular in 2013/14 we have consulted widely on the development of our Commissioning Intentions and our Five Year Plan; specialist mental health services; the Prostate Local Enhanced Service; and patient choice regarding first outpatient appointments. We have a comprehensive programme of engagement with patients and carers to collect their experiences of services in South Tyneside and have a wide range of patient stories. The South Tyneside Foundation Trust incorporates those stories into their comprehensive Carer and Patient Involvement Programme.

As part of the ‘Call to Action’ to inform local people of the CCG’s plans and encourage feedback we have presented ideas to

9


HealthNet, the Patient Reference Group, Local Engagement Board, South Tyneside’s People’s Select Committee and the Overview and Scrutiny Committee. Patient and public feedback was recorded during meetings for consideration in future planning decisions.

This year, through our Commissioning Support Unit, we have continued to work closely with other local NHS organisations to support the regional working that has been a legacy of the Equality, Diversity and Human Rights Regional Leads Meetings.

Improving performance integration and partnershipsOur membership of the South Tyneside Health and Wellbeing Board

As set out in the Government’s Health White Paper ‘Healthy People Healthy Lives’ (2011), our partners South Tyneside Council have been given responsibility for health improvement in the borough and for ensuring that health, adult and children services are joined up through the creation of a new Health and Wellbeing Board.

Our Btter Health and Wellbeing Strategy provides the overarching framework for our Health and Wellbeing Board to agree commissioning plans for the NHS, social care, public health and other services. The strategy concentrates on a small number of agreed strategic priorities that will make a significant difference to increasing the health and wellbeing of all people in South Tyneside.

We ensure we focus our combined efforts where we can make the biggest difference for local people. Our strategy focuses on four key areas:

1. Improving health and wellbeing and reducing inequalities through prevention and early identification of risk

2. Tackling youth unemployment

3. Reducing social isolation in older people

4. Improving the quality, integration and efficiency of local services provided by South Tyneside Council, NHS and partners

By focusing on a small number of selected priorities, the Health and Wellbeing Board are in a better position to develop, integrate and embed action across sectors and services that will support the achievement of agreed outcomes. Our vision is to:

“Work in partnership to improve the health, wellbeing and quality of life for our children, adults and families and reduce health inequalities, to help people live longer and healthier lives.”



The South Tyneside Health and Wellbeing Board’s ‘plan on a page’ identifies the following key objectives:

• Every child to have a good start in life

• Increased healthy life expectancy with reduced difference between communities

• Better employment prospects for young people

• Better mental health and emotional wellbeing for older people

• High quality, integrated, efficient local services designed around people

This is underpinned by involving people in ‘Our Better Health and Wellbeing Strategy’.

The Health and Wellbeing Board is chaired by Councillor Iain Malcolm, who is also leader of South Tyneside Council, and the membership is made up of the senior leaders of the council and local partner organisations including:

• Ourselves, NHS South Tyneside Clinical Commissioning Group

• South Tyneside NHS Foundation Trust

• Northumberland, Tyne and Wear NHS Foundation Trust

• Healthwatch South Tyneside

• NHS England Local Area Team

We also invite local representatives from voluntary and community sector groups as needed.

Our key improvements include:

• Developing improved interventions to prevent obesity across the lifespan

• Adopting an integrated approach to prevention and early intervention and embed a risk and resilience model for young people

• Focused work on early identification of cancer, heart disease and dementia

• Developing the Change4Life Integrated Wellbeing Model for lifestyle services including emotional health and wellbeing

• Strengthening engagement between schools, colleges and business

• Developing a comprehensive approach to reducing social isolation in older people and other vulnerable groups

An integrated South TynesideWhy integrate?

Integration of health and social care is an opportunity to improve the lives of all residents in South Tyneside, promoting equity by engaging some of the most vulnerable people in our society. We must give them control, placing them at the centre of their own care and support, make their dignity paramount and, in doing so, provide them with a better service and better quality of life.

Unless we seize this opportunity to do something radically different, then services

11


will get worse, costs to taxpayers will rise, and those who suffer the most will be people who could otherwise lead more independent lives.

Our partnership believes that health inequalities are unfair, unjust and most importantly preventable. Reducing health inequalities is central to better care. There is recognition from our Joint Strategic Needs Assessment that levels of deprivation continue to be a challenge. Cancer and circulatory disease remain major factors in the gap in life expectancy across South Tyneside and also between the borough and the rest of the country with respiratory conditions increasing.

Levels of smoking, alcohol use, obesity and depression are also higher than the national average. The number of older people is expected to rise dramatically by 2030. However we are addressing these challenges in a positive way – ‘assets’ work with local people and the voluntary sector has identified the desire for change and we will maximise this in our work.

Embracing the opportunities

We embrace the opportunities which present around integration and have developed an integration board, which is attended by a range of key health and social care partners, to oversee a number of exciting developments related to moving forward with integration at scale and pace across the borough.

All major stakeholders have made a firm commitment to the delivery of integration across South Tyneside,

in particular by the Health and Wellbeing Board. This has been demonstrated through our early success in becoming an integration pioneer site, with an early, primary focus on self-care which is being delivered against a backdrop of significant stakeholder and partner engagement.

We have identified four key transformation programmes to underpin integration in South Tyneside and work on these will continue over the coming months:

• Development of Health and Social Care Integrated Community Teams

• Developing the Change4Life Integrated Wellbeing Model for lifestyle services including emotional health and wellbeing

• Implementation of an Integrated Care Hub (for dementia and re-ablement)

• The development and delivery of a standardised self-care offer across health and social care, including workforce and cultural change to help individuals to help themselves (this is our Integration Pioneer work; see section overpage).



Developing a shared vision

Our partnership vision for an integrated South Tyneside is:

Better outcomes for patients

Through our planned changes, patients and service users will experience shared approaches to care planning and better information sharing between teams and across professional boundaries, reducing the need for the patient or service user to repeat their story to multiple professionals and ensuring a higher standard of care more generally. We very much anticipate that patient, care and service user experience will significantly improve as a result of these activities and that over reliance on traditional models of statutory services will decrease.

We are ensuring that people will have choice and control via the delivery of personal health budgets for adults and children within continuing care which are being introduced on 1 April 2014.

An integration pioneer

South Tyneside is proud to be one of 14 integration pioneers nationally.

As a result of the challenges which the health and social care system has faced, national health and social care organisations felt an urgent need to tackle demand pressures in health and social care.

Integration Principles

We will impose a patient

perspective throught our

work

We will manage the organisational

consequences of being person-

centred

Our staff will not automatically

reach for traditional solutions

We will develop our staff jointly, not separately

“I can promote my own health and wellbeing by planning my care & support with people who work together to understand me and my carers, allow me

control and bring together services to acheive the outcomes important to me”

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There were over 100 expressions of interest for the pioneer project across the UK with the aim to identify pioneers of integrated care ‘at scale and pace’, in an innovative way. The pioneer programme will provide support and advice to help overcome barriers to integration and pioneers should be ‘leaders across the entire system’ rather than just ‘pilots’. South Tyneside partnership were successful in their application and are now one of fourteen areas ‘leading the way in delivering better joined up care’.

Outcomes and objectives

We have two key outcomes in mind and these are:

• Improved health, wellbeing and independence of South Tyneside residents

• Reducing demand on statutory services (especially unplanned care)

Our three objectives are to:

• Promote independence by helping the public to help themselves

• Promoting self-care to improve the effectiveness of service users self-management (skills, knowledge, permissions, networks, increased expectations)

• Shift conversations from: “How can I help you?” to “How can I help you to help yourself”

We intend to meet these outcomes and objectives through a series of new

interventions which include:

• Individual treatment and self-care plans

• Self-monitoring devices, assistive technologies, home adaptations

• Self-care built into rehabilitation services

• Physical activity programmes

• Wellbeing and life skills courses

• Weight management advice

• Disease specific education programmes

• Community, voluntary and peer support networks

• Buddying and befriending schemes

At the end of the programme we will know that we have been successful as we will see that:

• Local people are better supported to live independent and healthy lives by making better use of a wider range of local support services

• Patients and carers are supported to build their skills, knowledge and confidence in looking after themselves and to challenge the quality of local services

• There will be fewer ‘crisis’ interventions, and more planned engagement

• Joint workforce development promotes consistent messages and empower staff to work beyond professional boundaries



Improving performance

We have worked hard throughout the year to establish ourselves as an effective commissioner, to improve the services which we commission on behalf of patients and to meet our local and national performance standards. We have used national measurements on a local level in order to provide an overview of how we are performing within South Tyneside. The next few pages describe some of the metrics that we use in order to improve our patients experience and how we make best use of resources.

Ambulance performance

4 hour waits

Number of A&E Attendances

Ambulance response time

Ambulance handovers

A&E waits from DTA to admission >12 hours

Due to the way that our commissioning arrangements work across the North East for ambulance services, it should be noted

that these relate to North East Ambulance Service in totality and are not split by CCG. The information illustrates that four hour waiting times and A&E attendance standards were routinely met, along with ambulance response times (with the exception of January).

However, it is illustrated that ambulance handover standards were not always achieved and high demand during winter months created additional pressure in the system more generally.

We have worked closely with partners during the winter period to oversee the overall performance of the health and social care system in South Tyneside to make sure that our local systems are operationally resilient. Lessons learned from winter 2013/14 will be reviewed in the early part of 2014/15 to inform future winter and operational resilience planning.

Due to the different timetables for reporting, the period for the indicators described below is as follows:

• A&E 4 hour waits – December 2013

• A&E Attendances – March 2014

• Ambulance Response times – December 2013

• Ambulance handovers – February 2014

Cancer waiting times

Cancer waiting times

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Standards in relation to cancer pathways exist to ensure that patients get the right treatment at the right time for their condition. Standards to reduce cancer waits have been met for eight of the nine categories. The category which underperformed was for the 62 day urgent referral from NHS screening service category (currently at 85.7% which is below the 90% target). On every occasion where a breach occurs, a root cause analysis is carried out and reviewed by doctors and nurses to understand why it occurred and to prevent it happening again. A number of themes are being explored, including why some patients might choose to change important appointment times or indeed fail to attend, thus impacting on the overall timing of the 62 day pathway.

Note: Cancer waits – as at January 2014

Reduction in avoidable emergency admissions

Reduction in avoidable emergency admissions

Out of the four avoidable admission indicators, we have achieved the standards for reducing the number of people having an unplanned hospital admission for chronic ambulatory care sensitive conditions, admission conditions that do not require hospitalisation, and admissions for children with lower respiratory tract infections. However, we have not achieved “unplanned hospitalisation for asthma, diabetes and epilepsy (for the under 19 age group)” at the year to date position.

This shows that more younger people are being admitted to hospital for these conditions than anticipated and whilst the actual numbers involved are small, we are reviewing this to understand what we can do to improve this going forward.

Note: Avoidable admissions – as at January 2014

Healthcare acquired infections

MRSA

Clostridium difficile

Working against a zero tolerance standard, we have had two incidences of MRSA over the period April 2013 – January 2014, with one case having occurred in May 2013 and one in January 2014.

The yearly standard for incidence of Clostridium difficile is that we should not exceed 26 cases; the current position as at 31 January 2014 shows 32 cases, which means that we are above the anticipated position. Over the past 10 months the monthly target has been breached in six months.

In order to tackle this, a partnership has been established between the CCG, South Tyneside NHS Foundation Trust and City Hospitals Sunderland NHS Foundation Trust to develop an integrated action plan.



Note: Healthcare associated infections – as at January 2014

Referral to treatment

Referral to treatment

52 week waiters

It is important that patients are seen in a timely fashion and in accordance with NHS Constitutional Standards. Our performance for referral to treatment pathways treated within 18 weeks is all above the required standard. The current position as at 31 January 2014 is 94% of patients who need to be admitted and 99% of patients that did need to be admitted have met the standard. For diagnostic tests we are achieving the standard with no patients waiting over six weeks.

There were no patients waiting over 52 weeks for the period April 2013 – January 2014

Patient experience

Each year NHS England commissions a national GP Patient survey to assess patients’ experiences of their local NHS services. The GP Patient Survey has been designed to give patients the opportunity to comment on their experience of their GP practice. The survey asks patients about a range of issues related to their local GP surgery and other local NHS services. This

includes questions about how they rated their experience of GP services, out of hours’ services and how confident patients felt in managing their own care.

We are above average for people’s overall experience of their GP within South Tyneside, with 54% saying their experience was very good compared to the national average of 44%

Very Good %

44%

54%

Fairly Good %

42%

35%

Neither Good or Bad %

9%

8%

Fairly Poor %

3%

4%

Very Poor %

1%

National Average


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GP Patient Survey – December 2013 results http://www.gp-patient.co.uk/results/latest_weighted/ccg/contains results for every CCG in the country and the national results, using aggregated data collected during January-March 2013 and July-September 2013.

Out of hours experience

For out of hours experience, 38% rate us as having a very good experience (above average) and 34% saying that they have a fairly good (below average).

GP Patient Survey – December 2013 results http://www.gp-patient.co.uk/results/latest_weighted/ccg/ contains results for every CCG in the country and the national results, using aggregated data collected during January-March 2013 and July-September 2013.

Managing own health

Increasing patients’ confidence in managing their own condition is a key area of focus over the next two years, given the levels of long term illness already outlined. It is a key part of our integration pioneer work, supporting patient with self-care skills

Very Good %

29%

38%

Fairly Good %

39%

34%


16%

17%

Fairly Poor %

9%

4%

Very Poor %

7%

7%

National Average




so that they are better able to care for themselves.

GP Patient Survey – December 2013 results http://www.gp-patient.co.uk/results/latest_weighted/ccg/

contains results for every CCG in the country and the national results, using aggregated data collected during January-March 2013 and July-September 2013.

In terms of the public managing their own health in South Tyneside, we are very comparable to the national average, with only very slight differences.

The year in focusIn July 2013, Women’s Health in South Tyneside (WHIST) was presented with a national Bevan Prize for outstanding work in Health and Wellbeing. Over the past 27 years, WHIST has amassed over 3,000 members with 350 women accessing its range of services each week, including addiction support, rape crisis aid, a credit union and pre-vocational training.

The Workplace Health Alliance was launched in April 2013 with the aim of redressing poor health statistics in South Tyneside through the promotion of healthy lifestyles and wellbeing to staff members via health-conscious employers. We signed up to the Alliance and will be working towards the Better Health at Work bronze award which will be assessed next year.

In 2013 plans to strengthen performance in urgent and emergency care were put in place across the country to help hospital A&E departments meet demand and tackle waiting time pressures. In South Tyneside, a new Urgent Care Delivery Group was

Very Good %

29%

38%

Fairly Good %

39%

34%


16%

17%

Fairly Poor %

9%

4%

Very Poor %

7%

7%

National Average


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created, which includes representatives from our CCG, GP representation, the Council, South Tyneside Hospital as well as Northumberland, Tyne and Wear mental health trust, North East Ambulance Service and Northern Doctors Urgent Care.

From April 2014, South Tyneside residents with chronic conditions who are unable to leave their homes will receive better care as a result of a district nursing service review by NHS South Tyneside CCG and South Tyneside NHS Foundation Trust. Vulnerable people with long term conditions who have mobility problems that prevent them from attending their GP surgery will now be offered routine condition monitoring in their own home.

We were one of the top three finalists for the Sharing Best Practice Lean Healthcare Management Award 2014 for its Quality and Demand Management project. We worked with local practices to improve the quality of referrals from primary to secondary care in the areas of general

surgery, gynaecology and orthopaedics. Feedback from the project has shown that GPs knowledge and understanding has improved as a result of the project and patients are more informed about their condition. The quality of referrals has improved and, as a result, patients are given the most appropriate treatment for their condition. In addition, financial savings have been estimated at £500,000.

In June 2013, we published our first ever prospectus. The 15 page document provides an introduction for audiences to the role of the CCG is and an overview of ambitions and plans we propose for the local population’s health service.

The South Tyneside Improving Care Scheme (STICS) was developed in 2013 to improve care for ‘seldom seen’ and housebound patients with long term conditions. The scheme supported practices to work in a coordinated way with community services, the local authority and third sector organisations to improve quality of care for patients and reduce emergency hospital admissions. By the end of December 2013, 79% of STICS patients had been seen by practices and ten of the GP practices had seen a reduction in emergency admission costs in the patient group.

We took part in the winter self-care campaign launched in November 2013, collaborating with CCGs in Northumberland, Tyne and Wear, County Durham, Darlington and Teesside. The campaign encouraged normally healthy people to focus on self-care and the main winter respiratory illnesses, that can be looked after at home or with advice from



a pharmacist. The aim was to minimise GP appointments for minor illness freeing up GP capacity to deal with more complex health issues, and to help free further

urgent care capacity.

Engagement for better services

During the year, we have asked local people to give their views and experiences to help shape local health services. Over 28 patient stories were collected covering a wide and varied range of services. They provided us with information about patient and carer experience of a variety of services including various wards and departments in South Tyneside NHS Foundation Trust, community services, North East Ambulance Service and mental health services. Stories were forwarded to the relevant provider to highlight both positive and negative experiences.

A consultation on mental health took place throughout 2013, where we asked South Tyneside residents to have their say on new proposals for mental healthcare provision in the borough. The aim was to treat more people in their own home, or close to home but an appeal was made for views from local people to ensure the approach was suitable for patients, their families and carers.

Five Local Engagement Board meetings were held during the year inviting local residents to give their views on the future of South Tyneside healthcare. People were updated on services and future plans for healthcare in the borough with the

opportunity to ask questions and meet representatives of the CCG.

Promoting good healthWe have supported a range of high profile promotional campaigns over the course of the year.

Our ‘Keep Calm and be ready for winter’ campaign was designed to signpost local people to the right NHS service for their needs and remind them that many common winter ailments and illnesses are easily treated at home, or with advice from a pharmacist – with no need to see a doctor or nurse. The seven-week campaign was launched in November 2013 to coincide with the busy winter period. Over this time it featured heavily in regional and social media reaching a projected 1.38 million people. The campaign message of ‘Keep Calm and look after yourself’ ran across three threads including:

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• Keep Calm and ask a pharmacist

• Keep Calm and call 111

• Keep Calm and antibiotics aren’t always the answer

The ‘My Medicines, My Health’ promotion started in February 2014. Collaboratively funded by the region’s 12 CCGs, it was designed to encourage people over 60 years with long-term medical conditions to keep on top of their illness by storing all their medicines in one place, a ‘green bag’, and take them to any key medical appointments. The campaign was advertised on regional TV, radio and in shopping centres.

‘The earlier, the better’ campaign ran from January to March 2014 and encouraged people to seek help early on from their local pharmacist if they were feeling under the weather. Targeting over 45s through a range of channels, and the over 60s through their friends, family and carers, the campaign asks people to get advice from their local pharmacist or from www.nhs.uk/asap to prevent a minor illness developing into something more serious, requiring a trip to hospital.

Sustainability and the environment We are committed to work in ways which maximise the health, social and economic benefits our activities bring to the community while minimising our impact on the environment.

Sustainable development requires us to be mindful of the need to safeguard the future in all of our choices, decisions and actions. Wherever possible we encourage staff and colleagues to contribute positively to the local economy and community, reduce waste and utilities consumption, and minimise any negative impact on the environment both now and for future generations.

Working in a sustainable way means rethinking a lot of what we do. It affects not only the major strategic decisions we take but also how we go about our daily business.

Getting these decisions right will not only help us save money, eliminate unnecessary waste in the system and reduce our carbon footprint; it demonstrates to partners and the public that we are dedicated to enhancing individuals’ well-being through our work as commissioners of high quality health services, but also by enhancing the wellbeing of the local and global community through taking seriously our corporate responsibilities.

Travel

We encourage sustainable travel wherever possible. We have an electric car which staff are encouraged to use locally and we have bike storage facilities. We also promote care closer to home, telehealth and home working opportunities.

Energy use

We monitor our energy usage and uses renewable resources where feasible.



Waste

We work hard to minimise the creation of waste and we have a robust approach to recycling. Paper, cardboard, glass, metal, ink cartridges, batteries, waste electrical goods and confidential waste are all recycled.

Workforce development

All of our staff are encouraged to work sustainably, we promote environmental awareness, encourage low carbon travel and facilitate flexible working where possible.

Equality and diversityWe comply with the Equality Act 2010 and the Public Sector Equality Duty and we have demonstrated our commitment to taking Equality and Human Rights into account in everything we do, whether that is commissioning services, employing people, developing policies, communicating, consulting or involving people in our work as shown below:

The Equality Delivery System (EDS)

The EDS is a tool that has been designed by the NHS for the NHS to enable organisations to analyse equality performance, prepare equality objectives and embed equality into mainstream commissioning activities.

We adopted the Equality Delivery System (EDS) framework and have been using the tool to support the mainstreaming of equalities into all our core business

functions and also used it as an opportunity to raise equality in service commissioning and performance for the community, patients, carers and staff.

We have developed and published our equality objectives for 2013/14 and approved plans detailing actions we will take to ensure that individuals, communities and staff are treated equitably. Progress against these action plans is regularly reported to our Executive Committee.

Staff training

Equality and Diversity training is a mandatory requirement for our staff and anyone involved in recruitment is required to undertake recruitment and selection training which includes awareness of equality and diversity legislation.

Diversity Matters newsletter

Our CCG Commissioning Support Unit produces a quarterly newsletter which is made available to all our staff and which contains up-to-date information on relevant equality diversity and human rights legislation and developments.

Equality analysis

In 2013 we refreshed our Equality Analysis (EA) Toolkit and Guidance which covers all equality groups offered protection under the Equality Act 2010 (Race, Disability, Gender, Age, Sexual Orientation, Religion/Belief, Marriage and Civil Partnership and Gender Re-assignment) in addition to Human Rights and Carers.

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Governance

Equality and diversity is governed and reports into the Executive Committee. The Committee ensures we are compliant with legislative, mandatory and regulatory requirements regarding equality and diversity. The committee develops and delivers national and regional diversity related initiatives within our CCG, providing a forum for sharing issues and opportunities. It also functions as a two-way conduit for information dissemination and escalation, monitors progress against the equality strategy and supports us in the achievement of key equality and diversity objectives.

Accessibility and communications

We ensure that our public buildings are accessible for people with a disability by ensuring all buildings have had disability access audits.

We have also earned the two tick ‘positive

about disabled people’ symbol awarded by Jobcentre Plus which demonstrates our commitment to employ, retain and develop the abilities of disabled staff.

We use everyday language solutions when an interpreter is required by telephone and for face-to-face interpreting. Information for patients and the general public is available in other languages or formats on request.

Compliments and complaints

We welcome feedback, positive or negative, about people’s experience of local NHS services as this helps us to improve services for patients.

Equal opportunities for staff

We can demonstrate fair and equitable recruitment, workforce engagement and employment terms and conditions to ensure levels of pay and related terms and conditions are fairly determined.

Male Female

Governing Body Members 7 2

Very Senior Managers 1 3

CCG Employees 2 17

Members report Details of members of the Membership Body and Governing body The member practices of the clinical commissioning group are:

• Victoria Medical Centre • Farnham Medical Centre • Marsden Road Health Centre • Mayfield Medical Centre • Dr A Haque • Talbot Medical Centre • Wawn Street Surgery • Trinity Medical Centre • Dr Thorniley-Walker and Partners • Albert Road Surgery • Westoe Surgery • Ellison View surgery • Central Surgery • Stanhope Parade Health Centre • St George Medical Centre • Colliery Court Medical Group • Dr Chander • The Glen Medical Group • Whitburn Surgery • Drs Dowsett and Overs • Imeary Street • The Park Surgery • Ravensworth Surgery • Chichester Practice • East Wing Surgery • Flagg Court • Trinity Riverside Practice • Jarrow GP Practice

The names of the Chair and Accountable Officer throughout the year and up to the signing of the Annual Report and Accounts are:

• CCG Chair – Dr Matthew Walmsley • Chief Officer – Dr David Hambleton

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The composition of each of the Membership Bodies (which operates as an formal body) and Governing Body throughout the year and up to the signing of the Annual Report & Accounts (including advisory and lay members): Council of Practices membership Nominated lead GPs

• Dr Rakesh Bhalla • Dr Martin Brady • Dr Steve O’Donnell • Dr Somesh Chander • Dr Duane Cordner • Dr James Gordon • Dr Dawn Elliott • Dr M A Haque • Dr Simon Hutchinson • Dr Vickie Local • Dr Helen McManus • Dr Paul Nellist • Dr Funmi Nixon • Dr Karen Overs • Dr John Perrins • Dr Damien Power • Bunty Prasad • Dr Forood Ranaie • Dr Will Rose • Dr Sal Salaudeen • Dr Anthony Stone • Dr Edward Thorniley-Walker • Dr IP Vinayak • Dr S Vis-Nathan • Dr Matthew Walmsley • Dr NE Win

Practice Managers

• Natalie Billins • Aidan Berry • Anne Bull • Alison Campbell • Kay Clark

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• Carol Craggs • Lee Cramman • Lynn Crutwell • Mary Davidson • Shirley Ford • Debbie Hamilton • Alison Heslin • Dallas Hitchinson • Carole Hutchinson • Stacey Kean • Rosemary Long • Mary Lynch • Emma Graham • Irene McConnachie • Jane Moore • Hazel Purvis • Sharon Richards • Marion Slater • Matthew Swatton • Sharon Thompson • Susan Bridle • Ros Whitehead

Governing Body Membership

• Dr Matthew Walmsley, CCG Chair • Dr David Hambleton, Chief Officer • Mr Stephen Clark, Lay Member/Deputy Chair • Dr Tarquin Cross, Secondary Care Consultant • Mrs Christine Briggs, Director of Operations • Mrs Ann Fox, Director of Nursing, Quality and Safety • Mr Jeff Gosling, Lay Member • Ms Kate Hudson, Chief Finance Officer • Mr Paul Morgan, Lay Member • Dr Vis Nathan, Elected GP Member • Amanda Healy, Director of Public Health • Mrs Helen Watson, Corporate Director of Children, Adults & Families, South

Tyneside Council

The names of the individuals forming the Audit Committee throughout the year and up to the signing of the Annual Report and Accounts: Audit Committee Membership

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• Paul Morgan, Chair • Jeff Gosling, Lay Member • Stephen Clark, Lay Member

In attendance

• Mr Martin Barnes, Senior Manager Mazars • Mr Paul Bevan, Counter Fraud Specialist • Ms Kate Hudson, Chief Finance Officer • Mr Cameron Waddell, Director and Engagement Lead Mazars

Reference to the Governance Statement for details of members of other committees and sub-committees and details on all committees and subcommittees: Quality, Patient Safety and Risk Committee Membership

• Stephen Clark, Lay Member/Chair • Dr Matthew Walmsley, CCG Chair • Dr David Hambleton, Chief Officer • Dr Vis-Nathan, GP Governing Body Member • Ann Fox, Director of Nursing, Quality and Safety • Jeff Gosling, Lay Member • Tarquin Cross, Secondary Care Consultant

In attendance

• Carol Drummond, Head of Safeguarding • Jeanette Scott-Thomas, Head of Quality & Patient Safety • Jon Tose, Clinical Director • Helen Smith, Operations and Engagement Manager

The Governing Body profiles and the conflicts of interest can be found in the remuneration report on page 38. Pension liabilities Details of the accounting for pension liabilities can be found in the accounting policies and pension costs notes in our financial statements (notes 1.9.2 and 4.5 respectively). Further details of directors’ pension benefits can be found on page 34 of the remuneration report. Sickness absence data A table is included in the employee benefits note to the financial statements and shown in note 4.3 of the accounts.

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External audit Mazars are engaged to perform the external audit of the CCG for the year to March 2014. The scope of their work is a review of the financial statements and that will be conducted in accordance with International Standards on Auditing (UK & Ireland). Their work is focused on those aspects of our business that they consider to have a higher risk of material misstatement. Within their review they will consider our related party disclosures within the accounts. The cost of audit services was £60,000 for the financial year 2013/14. This was in relation to the statutory audit. Disclosure of serious untoward incidents We have had no serious untoward incidents. Further information is in the governance statement on page 45. Cost allocation and setting of charges for information We have complied with HM Treasury’s guidance on cost allocation and the setting of charges for information. Principles for remedy The Principles for remedy revised in May 2010, sets out six principles that represent best practice. The principles are:

• Getting it right • Being customer focused • Being open and accountable • Acting fairly and proportionately • Putting things right • Seeking continuous improvement

We have a policy for the management of complaints and concerns, which incorporates the principles outlined above.

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Employee consultation Throughout the last year, we have kept staff informed about the changes to the NHS both locally and nationally. This was done through internal bulletins, monthly staff partnership forums, bi-weekly executive team staff briefings, team meetings and on the staff intranet. Disabled employees We have policies in place where all employees are treated fair and equally. All staff undertake mandatory training which includes the equality and diversity legislation. Emergency preparedness, resilience and response We have an incident response plans in place, which are fully compliant with the NHS Commissioning Board Emergency Preparedness Framework 2013. We undertake regularly reviews and makes improvements to its major incident plan and has a programme for regularly testing this plan, the results of which are reported to the Governing Body. Statement as disclosure to auditors The Governing Body is not aware of any relevant audit information that has been withheld from our CCG’s external auditors, and members of the Governing Body take all necessary steps to make themselves aware of relevant information and to ensure that this is passed to the external auditors where appropriate. Dr David Hambleton Accountable Officer 4 June 2014

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Remuneration report Remuneration committee The remuneration committee was established to advise the Governing Body about pay, other benefits and terms of employment for the Chief Officer and other senior staff. The remuneration committee is established in accordance with South Tyneside Clinical Commissioning Group’s constitution, standing orders and scheme of delegation. The committee membership is as follows: Stephen Clark Matthew Walmsley Dr Vis Nathan Jeff Gosling Paul Morgan

Chair of Remuneration Committee/Lay Member CCG Chair GP Member of Governing Body Governing Body Lay Member Governing Body Lay Member

The remuneration committee has delegated authority from the Governing Body to make recommendations on determinations about pay and remuneration for employees of the CCG and people who provide services to the CCG. The remuneration for senior managers for current and future financial years is determined in accordance with relevant guidance, best practice and national policy. Continuation of employment for all senior managers is subject to satisfactory performance. Performance in post and progress in achieving set objectives is reviewed annually. There were no individual performance review payments made to any senior managers during the year and there are no plans to make such payments in future years. This is in accordance with standard NHS terms and conditions of service and guidance issued by the Department of Health. Contracts of employment in relation to all senior managers employed by the CCG are permanent in nature and subject to between three and six months’ notice of termination by either party. Termination payments are limited to those laid down in statute and those provided for within NHS terms and conditions of service and under the NHS Pension Scheme Regulations for those who are members of the scheme. No awards have been made during the year to past senior managers. For the purpose of this remuneration report, the definition of ‘senior managers’ is as per

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the CCG Annual Reporting Guidance published by NHS England:

Those persons in senior positions having authority or responsibility for directing or controlling the major activities of the clinical commissioning group. This means those who influence the decisions of the entity as a whole rather than the decisions of individual directorates or departments.

It is considered that the Governing Body and Executive Committee members represent the senior managers of the CCG. South Tyneside CCG Senior Officers 2013/14 Declarations of Interests

Name Title Declaration detail

Dr Matthew Walmsley GP Chair Partner in Marsden Road Health Centre Spouse is partner in Houghton Medical Group

Stephen Clark Deputy Chair/Lay Member

None

Jeff Gosling Lay Member Trustee Treasurer- South Tyneside Indigent Sick Society.

Paul Morgan Lay Member Chair of Board of Directors – East Durham Homes Ltd, Ecopanel Systems Ltd.

Dr Tarquin Cross Secondary Care Clinician

Consultant Geriatrician within Northumbria Health Care NHS Foundation Trust

Dr Sreeni Vis-Nathan GP Member Owner – Medics of Tyneside GP at Ravensworth Surgery

Dr David Hambleton Chief Officer Wife is Commissioning Manager with North of England Commissioning Service

Christine Briggs Director of Operations

None


None

Ann Fox Director of Nursing, Quality & Safety

Director – Communication Equation Ltd, Chair of Trustees – Mynewhair Charity

Dr Jonathan Tose GP Clinical Director, Planned Care, Contracting and Quality In Primary Care

Salaried GP at Central Surgery

Dr James Gordon Clinical Director (Mental Health and Learning Disability)

Salaried GP at Trinity Medical Group – Part year GP at Imeary Street Surgery – Part year

Dr Funmi Nixon Clinical Director (Long Term Condition)

GP Special Interest Older People, Single-handed GP at Westoe

Ros Whitehead Practice Manager Lead

Practice Manager at Ellison View Surgery

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South Tyneside CCG Senior Officers Salaries & Allowances 2013/14

Name Title

2013/14

Salary & Fees Taxable Benefits Annual Performance Related Bonuses

Long-term Performance Related Bonuses

All Pension Related Benefits Total

(Bands of £5000)

(Rounded to nearest £000) (Bands of £5000) (Bands of £5000) (Bands of

£2,500) (Bands of £5,000) £000 £000 £000

Dr Matthew Walmsley

GP Chair 40-45 n/a n/a n/a n/a 10-45

Stephen Clark

Deputy Chair/Lay Member 10-15 n/a n/a n/a n/a 10-15

Jeff Gosling Lay Member 5-10 n/a n/a n/a n/a 5-10 Paul Morgan Lay Member 10-15 n/a n/a n/a n/a 10-15 Dr Tarquin Cross

Secondary Care Clinician 5-10 n/a n/a n/a n/a 5-10

Dr Sreeni Vis-Nathan

GP Member 5-10 n/a n/a n/a n/a 5-10

Dr David Hambleton

Chief Officer 115-120 11 n/a n/a 15-17.5 135-140

Christine Briggs

Director of Operations 85-90 n/a n/a n/a 10-12.5 95-100

Kate Hudson

Chief Finance Officer 90-95 5 n/a n/a 78-80.5 170-175

Ann Fox Director of Nursing, Quality & Safety 35-40 n/a n/a n/a n/a 35-40

Dr Jonathan Tose

GP Clinical Director, Planned Care, Contracting and Quality in Primary Care

55-60 n/a n/a n/a 148-150.5 205-210

Dr James Gordon

Clinical Director (Mental Health & Learning Disability)

40-45 n/a n/a n/a 145-147.5 190-195

Dr Funmi Nixon

Clinical Director (Long Term Condition) 40-45 n/a n/a n/a 27-29.5 70-75

Ros Whitehead

Practice Manager Lead 10-15 n/a n/a n/a n/a 10-15

Notes: As this is the first full year of the CCG there are no prior year comparatives to disclose.

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Pay Multiples Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the median remuneration of the organisation's workforce. The banded remuneration of the highest paid director in South Tyneside CCG in the financial year 2013/14 was £115,000- £120,000. This was 3.26 times the median remuneration of the workforce, which was £36,771. In 2013/14, full time equivalent remuneration for employees ranged from £9,613 to £137,637. Total remuneration includes salary, non-consolidated performance-related pay and benefits-in-kind, but not severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions.

2013/14

Band of Highest Paid Director's Total Remuneration (£'000) 115-120 Median Total Remuneration (£) 36,771 Ratio 3.26

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South Tyneside CCG Senior Officers Pension Benefits 2013/14

Name and Title Real increase / (reduction) in pension at age 60

Real increase / (reduction) in Pension Lump Sum at aged 60

Total accrued pension at age 60 at 31 March 2014

Lump Sum at aged 60 related to accrued pension at 31 March 2014

Cash Equivalent Transfer Value at 31 March 2014

Cash Equivalent Transfer Value at 31 March 2013

Real increase in cash equivalent transfer value

Employer’s contribution to stakeholder pension

(bands of £2500) (bands of £2500) (bands of £5000)

(bands of £5000)

£000 £000 £000 £000 £000 £000 £000 £000

Dr Matthew Walmsley GP Chair 0 – 2.5 2.5 - 5 0 - 5 5-10 35 15 20 6

Stephen Clark Deputy Chair/Lay Member n/a

n/a n/a n/a n/a n/a n/a n/a

Jeff Gosling Lay Member n/a n/a n/a n/a n/a n/a n/a n/a

Paul Morgan Lay Member n/a n/a n/a n/a n/a n/a n/a n/a

Dr Tarquin Cross Secondary Care Clinician n/a n/a n/a n/a n/a n/a n/a n/a

Dr Sreeni Vis-Nathan GP Member n/a n/a n/a n/a n/a n/a n/a n/a

Dr David Hambleton Chief Officer 0 – 2.5 2.5 - 5 35 - 40 115 - 120 693 636 43 17

Christine Briggs Director of Operations 0 – 2.5 2.5 - 5 25 - 30 75 - 80 383 351 24 12

Kate Hudson Chief Finance Officer 2.5 - 5 10 - 12.5 20 - 25 60 - 65 309 240 64 13


5 – 7.5 17.5 - 20 30 - 35 100 - 105 575 453 122 6

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Dr Jonathan Tose GP Clinical Director, Planned Care, Contracting & Quality in Primary Care

5 – 7.5 20 – 22.5 5 - 10 25 - 30 135 45 89 8

Dr James Gordon Clinical Director (Mental Health & Learning Disability)

5 – 7.5 17.5 - 20 7.5 - 10 25 - 30 112 31 81 6


0 – 2.5 2.5 - 5 0 - 5 5 - 10 45 32 13 6

Ros Whitehead Practice Nurse Lead n/a n/a n/a n/a n/a n/a n/a n/a

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Cash Equivalent Transfer Values A cash equivalent transfer value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefit accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries. Real increase in Cash Equivalent Transfer Values This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee, (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period.

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Membership Body and Governing Body profiles Council of Practices The CCG Council of Practices is the Membership Body of the CCG. It comprises a GP representative from each of the 28 Member Practices, acting on behalf of the Practice in dealings with the CCG and to representing the Member Practice at meetings of the Council of Practices. The Council of Practices is chaired by Dr Matthew Walmsley Governing Body and senior management profiles Dr Matthew Walmsley, Chair Matthew trained in the North East and has spent his entire career in the region. He has been a partner at the Marsden Road Health Centre for eight years. His main areas of interest are mental health and substance misuse. He has been involved in teaching medical students and training junior doctors for a number of years. Dr Tarquin Cross, Secondary Care Consultant Tarquin moved from London to Newcastle in 1991 to study Medicine and has stayed in his adopted North East ever since. He has trained and worked in numerous hospitals across the region before taking up a consultant post in Elderly Medicine with Northumbria Healthcare NHS Foundation Trust in 2007. He is currently Associate Head of Service for Acute Elderly Medicine and is involved in the development of the trust’s new Specialist Emergency Care Hospital and base sites project. Mrs Christine Briggs, Operations Director Christine has worked extensively in the NHS for past 23 years, having carried out a range of roles relating to primary care commissioning, general management and commissioning. Most recently she was Head of Commissioning Development for NHS South of Tyne and Wear, leading a small team to set up the new clinical commissioning group. As Director of Operations, Christine is responsible for day-to-day management. Responsibilities include oversight of the CCG’s commissioning responsibilities for children and adults, planning and performance, patient and public involvement, organisational development and, governance and corporate services. Mr Stephen Clark, Lay Member and Deputy Chair Stephen previously served as Primary Care Trust (PCT) Chair for South Tyneside and latterly PCT Cluster Chair for NHS South of Tyne and Wear. Until his retirement in 2007, he was Chief Executive of ENTRUST, one of the largest business development organisations in the North East. Stephen spent 27 years in local government and held the post of Chief Executive of

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South Tyneside Council. As well as operating as Chair of the Quality, Patient Safety and Risk Committee, he will also Chair the Remuneration Committee, act as Deputy Chair of the Governing Body and lead the Governing Body’s response to the Francis Report recommendations. Mr Jeff Gosling, Lay Member Jeff recently operated as Audit Chair of South Tyneside Primary Care Trust. He has been a Non-Executive Director since 2002 following his retirement from the post of Managing Director of a manufacturing firm. An accountant by profession, Jeff has had a successful career in industry primarily in the manufacture of textile machinery. This included five years in South Korea where he was involved in establishing a joint venture company. Mrs Ann Fox, Director of Nursing and Quality As a registered nurse and with a career in the NHS spanning 29 years, Ann has always been an advocate for improving the quality of patient care, their safety and their overall experience. She has been instrumental in developing new services and clinical pathways in haematology/oncology, palliative care and in her role as Nurse Director for the North of England Cancer Network. From 2009 Ann was Director of Clinical Care and Patient Safety (Executive Nurse) at the North East Ambulance Service NHS Foundation Trust. Dr Vis Nathan, Elected GP Member Vis has been working as a GP in South Tyneside for over 30 years. During this time he has been actively involved in local committees, acting as Chair of both the Local Medical Committee and the Practice Based Commissioning group. He is passionate about the health of the local community and the NHS. Dr David Hambleton, Chief Officer David studied medicine at Manchester and worked in Chester, Liverpool and the West Midlands before returning to his native North East as Consultant Geriatrician at City Hospitals Sunderland. Here he held a number of clinical managerial posts, including Head of Performance and Clinical Governance and Director of Surgery. Before taking up his current role, he was Director of Commissioning and Reform at NHS South of Tyne and Wear. Kate Hudson, Chief Finance Officer Kate has worked extensively in the NHS, most recently as Head of Finance for NHS South of Tyne and Wear working on behalf of Sunderland Teaching PCT, South Tyneside and Gateshead PCTs. Prior to this Kate was based in Essex and was Joint Acting Director of Finance for Epping Forest Primary Care Trust for four years. Amanda Healy, Director of Public Health Amanda is responsible for all services to relating to public health at South Tyneside Council.

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Helen Watson, Corporate Director of Children Adults and Families, South Tyneside Council Helen is responsible for all services which support children, adults and families. Mr Paul Morgan, Lay Member Paul qualified as a solicitor in London before moving to the North East in 1980. He has spent over 30 years as a lawyer and senior executive in the engineering industry, principally as a director of operating companies in the Rolls-Royce Group. He is currently a director and founding shareholder in a process engineering company. He is also Chair of the Board of East Durham Homes, an Arm’s Length Management Organisation which manages 8,500 homes on behalf of Durham County Council. The structure of the board committee and the names and dates of service can be found in the governance statement on page 48.

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South Tyneside CCG Senior Officers 2013/14 Declarations of Interest Name Title Declaration detail

Dr Matthew Walmsley

GP Chair Partner in Marsden Road Health Centre, Spouse is partner in Houghton Medical Group

Stephen Clark Deputy Chair/Lay Member

None

Jeff Gosling Lay Member Trustee Treasurer – South Tyneside Indigent Sick Society

Paul Morgan Lay Member Chair of Board of Directors – East Durham Homes Ltd, Ecopanel Systems Ltd

Dr Tarquin Cross Secondary Care Clinician

Consultant Geriatrician within Northumbria Health Care NHS Foundation Trust


GP Member Owner – Medics of Tyneside. GP at Ravensworth Surgery

Dr David Hambleton Chief Officer Wife is Commissioning Manager with North of England Commissioning Service

Christine Briggs Director of Operations

None


None


Director – Communication Equation Ltd, Chair of Trustees – Mynewhair Charity

Dr Jonathan Tose GP Clinical Director, Planned Care, Contracting and Quality In Primary Care

Salaried GP at Central Surgery

Dr James Gordon Clinical Director (Mental Health and Learning Disability)

Salaried GP at Trinity Medical Group – Part year GP at Imeary Street Surgery – Part year


GP Special Interest Older People, Single handed GP at Westoe

Ros Whitehead Practice Manager Lead

Practice Manager at Ellison View Surgery

Dr David Hambleton Accountable Officer 4 June 2014

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Statement by the Accountable Officer Statement of Accountable Officer’s responsibilities The National Health Service Act 2006 (as amended) states that each clinical commissioning group shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning Board (NHS England). NHS England has appointed Dr David Hambleton to be the Accountable Officer of the clinical commissioning group. The responsibilities of an Accountable Officer, including responsibilities for the propriety and regularity of the public finances for which the Accountable Officer is answerable, for keeping proper accounting records (which disclose with reasonable accuracy at any time the financial position of the clinical commissioning group and enable them to ensure that the accounts comply with the requirements of the Accounts Direction) and for safeguarding the clinical commissioning group’s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities), are set out in the Clinical Commissioning Group Accountable Officer Appointment Letter. Under the National Health Service Act 2006 (as amended), NHS England has directed each clinical commissioning group to prepare for each financial year financial statements in the form and on the basis set out in the Accounts Direction. The financial statements are prepared on an accruals basis and must give a true and fair view of the state of affairs of the clinical commissioning group and of its net expenditure, changes in taxpayers’ equity and cash flows for the financial year. In preparing the financial statements, the Accountable Officer is required to comply with the requirements of the Manual for Accounts issued by the Department of Health and in particular to:

• Observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis

• Make judgements and estimates on a reasonable basis • State whether applicable accounting standards as set out in the Manual for

Accounts issued by the Department of Health have been followed, and disclose and explain any material departures in the financial statements

• Prepare the financial statements on a going concern basis

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To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my Clinical Commissioning Group Accountable Officer Appointment Letter. Dr David Hambleton Accountable Officer 4 June 2014 Governance statement By Dr David Hambleton as the Chief Officer, NHS South Tyneside Clinical Commissioning Group Foreword The first year of South Tyneside CCG as a new statutory organisation came amidst a period of unprecedented change for the NHS. While the public sector has faced its most financially challenging time in living memory, the whole NHS architecture has been taken apart and refashioned. This has meant the establishment of new relationships such as with our commissioning support unit, North of England Commissioning Support, NECS, which have taken time to mature. It is not surprising therefore that this has been a particularly difficult time during which to ensure that we have robust flows of high quality information giving us a clear understanding of our key strategic risks and sound systems of control in place to manage them. It is important to be honest in my end of year assessment and to look back with an eye on the future to maximise the opportunities to ensure that we learn from our experiences of the past 12 months. For the first half of the year it is true to say that the reporting systems were still evolving and did not deliver the same standard of information that those of us who have come from previous NHS organisations were accustomed to receiving. However we have worked very hard to ensure that through our relationships with NECS we have gradually improved this situation and we are now much more comfortable with the level of detail and therefore assurance that we are receiving. It is also important to acknowledge that in setting up our new organisation, we did not always get our structures right. While we set out to establish a different style and

42

ethos and not simply reinvent old ways of working, we were also mindful not to ignore what had previously been shown to serve us well. This look back has been useful in enabling us to examine where our approach has been successful and where we need to make changes. So for example, the organisational risk management function which was intended to be undertaken by our Quality Patient Safety & Risk Committee, simply did not get the appropriate level of debate this year. We will therefore be recommending to the Governing Body that this important role transfers to the Audit Committee. We will also be reviewing the terms of reference for the Executive Committee itself to better reflect the pivotal role this committee plays in the running of the business of the CCG. In summary then, while this year has been one of immense upheaval for the NHS, it has been a period of transition that has been dealt with incredibly well and in a spirit of openness and honesty. I believe we leave it in far better shape to manage the risks to our organisation that will inevitably materialise in the year to come. Introduction and context The clinical commissioning group (CCG) was licenced from 1 April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the NHS Act 2006. The clinical commissioning group operated in shadow form prior to 1 April 2013, to allow for the completion of the licencing process and the establishment of function, systems and processes prior to the clinical commission group taking on its full powers. As at 1 April 2013, the clinical commissioning group was licensed without conditions. Scope of responsibility As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the clinical commissioning group’s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out in my Clinical Commissioning Group Accountable Officer Appointment Letter. I am responsible for ensuring that the clinical commissioning group is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity.

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Compliance with the UK Corporate Governance Code Whilst the detailed provisions of the UK Corporate Governance Code are not mandatory for public sector bodies, compliance is considered to be good practice. This Governance Statement is intended to demonstrate the clinical commissioning group’s had regard to the principles set out in Code. For the financial year ended 31 March 2014, and up to the date of signing this statement, we complied with the provisions set out in the Code, and applied the principles of the Code. The Clinical Commissioning Group Governance Framework The National Health Service Act 2006 (as amended), at paragraph 14L(2) (b) states: The main function of the governing body is to ensure that the group has made appropriate arrangements for ensuring that it complies with such generally accepted principles of good governance as are relevant to it. The CCG has a Constitution based on the Department of Health’s Model Template that has been amended and approved to take into account subsequent guidance. Review of the CCG’s Constitution confirms that it complies with the elements of the self-certification checklist, including:

• Specifying the arrangements made by the CCG for the discharge of its functions

• Specifying the arrangements made by the CCG for the discharge of the functions of the governing body

• The procedures to be followed by the CCG in making decisions; • The arrangements it has made to secure that individuals to whom health

services are being or may be provided pursuant to its commissioning arrangements are involved

• Arrangements made by the CCG for discharging its duties in respect of registers of interests and management of conflicts of interests

• Arrangements made by the CCG for ensuring that there is transparency about the decisions of the group and the manner in which they are made

Detailed Financial Policies and Scheme of Delegation During the year 2013/14 NHS South Tyneside Clinical Commissioning Group Governing Body met on 6 occasions in public for which there was an annual cycle of business. Agendas are structured to deal with strategic, performance, quality assurance, risk and governance issues. The arrangements meet the requirements of best practice guidance in respect of risk management and ensure that a strong accountability framework has been established; however as noted previously, the CCG intends to amend its committee structure to ensure risk issues are covered more fully. They reflect the public service values of accountability, probity and

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openness and specify as Chief Officer my responsibility for ensuring that these values are met within the Clinical Commissioning Group. Figure 1: Governing Body and Committee Meetings Attendance Record South Tyneside Clinical Commissioning Group members’ attendance record 2013/14 Name Title Audit

Committee Quality, Patient Safety & Risk Committee

Governing Body Committee

Remuneration Committee

Dr Matthew Walmsley

Chair 6 of 6 5 of 6 2 of 3

Dr David Hambleton

Chief Officer 5 of 6 6 of 6

Mr Stephen Clark

Lay Member/Deputy Chair

3 of 4 5 of 6 5 of 6 3 of 3

Dr Tarquin Cross

Secondary Care Consultant

3 of 6 5 of 6

Mrs Christine Briggs

Director of Operations 3 of 6 6 of 6

Mrs Ann Fox* Director of Nursing, Quality and Safety

3 of 6 3 of 6

Mr Jeff Gosling

Lay Member 2 of 4 5 of 6 5 of 6 2 of 3

Ms Kate Hudson

Chief Finance Officer 6 of 6

Mr Paul Morgan

Lay Member 4 of 4 6 of 6 3 of 3

Dr Vis Nathan

Elected GP Member 5 of 6 6 of 6 2 of 3

Ms Amanda Healy

Director of Public Health 5 of 6

Mrs Helen Watson

Corporate Director of Children, Adults and Families

6 of 6

* Please note that Mrs Ann Fox joined the CCG in May 2013 and therefore could not attend all the committee meetings. The Clinical Commissioning Group has continued to operate with a committee structure which reflects guidance and best practice, including Remuneration Committee, Audit Committee, Quality, Patient Safety & Risk Committee and Executive Committee. Terms of reference have been agreed for these committees which support the organisation in the delivery of effective governance. The organisational structure including key committees is set out below;

45

Description of the established Governing Body Committees The roles of each of the Governing Body Committees are set out broadly below. The Governing Body Committees have authority under the Scheme of Delegation to establish sub committees or sub groups to enable them to fulfill their role. Each of the Governing Body Committees has detailed Terms of Reference. Each Committee is authorised by the Governing Body to pursue any activity within their Terms of Reference and within the Scheme of Reservation and Delegation. Remuneration Committee The Committee is established to advise/recommend to the Governing Body the appropriate remuneration and terms of service for the Chief Officer and other staff paid through the Very Senior Manager Pay Framework. The Committee also advises/recommends to the Governing Body remuneration for the role of Chair, remuneration and terms of service of any independent lay members and Clinical Directors and reviews any business cases for early retirement and redundancy. The Committees terms of reference are referenced within the CCG’s Constitution and are available on the CCG’s website. Audit Committee In line with the requirements of the NHS Audit Committee Handbook and NHS Codes of Conduct and Accountability, the Committee provides the organisation with

Council of Practices

Governing Body

Remuneration Committee

Quality, Patient Safety & Risk

Committee

Prescribing Committee

Audit Committee

Executive Committee

Contract Operating

Group

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an independent and objective review of their financial systems, financial information and compliance with laws, guidance, and regulations governing the NHS. The Committee reviews the establishment and maintenance of an effective system of integrated governance, financial risk management and internal control, across the whole of the organisation’s activities. An annual Counter Fraud Plan is agreed by the Audit Committee which focuses on the deterrence, prevention, detection and investigation of fraud. The Committee is a non-executive committee of the Board and has no executive powers, other than those specifically delegated in its terms of reference. Annually the Committee also carries out a self-assessment of its effectiveness. The Committee’s terms of reference are referenced within the CCG’s Constitution and are available on the CCG’s website. The Audit Committee as part of its terms of reference provides an Annual Report of its work to the Governing Body. The most recent report will cover the year 2013/14. The principal purpose of the report is to give the Board an assurance as to the work carried out to support the Accountable Officer’s review of the internal control arrangements. The Committee’s cycle of business enables the Audit Committee to carry out its key objectives necessary to support its assurances regarding the effectiveness of the organisation’s internal controls. Quality, Patient Safety and Risk Committee The Quality, Patient Safety and Risk Committee was established as a committee of the Governing Body of the Clinical Commissioning Group, in accordance with the constitution, standing orders and scheme of delegation. The principal purpose of the Quality, Patient Safety and Risk Committee was to exercise on behalf of the Governing Body the functions that are delegated to it in respect of the development, implementation and monitoring of integrated risk and governance. In particular, by providing assurance on the systems and processes by which the Governing Body leads, directs and controls its functions in order to achieve its organisational objectives. In particular, it is responsible for ensuring the appropriate governance systems and processes are in place to commission, monitor and ensure the delivery of high quality safe patient care in commissioned services and to facilitate, monitor and ensure quality improvement in general medical practice working with the NHS Commissioning Board. On reflection, this has not been exercised as fully as originally intended as risk assurance has been picked up in a number of different committees, however it is recommended that this will be addressed during 2014/15 via the Audit Committee. The Committee had overall responsibility for reviewing the Corporate Risk Registers, (together with the Audit Committee), upon which reports were made to the Governing Body. The Committee’s terms of reference are referenced within the CCG’s Constitution and are available on the CCG’s website. Significantly during the year through its cycle of business, the Committee and its associated sub-committees have considered the following quality, risk, and safety

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and governance issues;

• Clinical Quality and Safety Highlight Report – acute, community health and mental health services

• Highlight Reports – safeguarding, care homes assurance, infection control • Patient experience • Risks register • Controlled Drugs Report (through an Annual Report) • Continued Health Care Update • Francis Enquiry • Quality Surveillance Group feedback • Quality in Care Homes • Information Governance Toolkit (set out further under para 6.2) • Public Health Protection assurance • Medicines Management Quality report and minutes • Management of Controlled Drugs arrangements relevant policy approval • Francis Inquiry Action plan • CQUIN 2013-2014 and CQUIN 2014-2015 (CQUIN refers to Commissioning

for Quality and Innovation – a national framework for securing improvements in quality of services and better outcomes for patients)

• Quality walk arounds • Policy approvals

Executive Committee The Executive Committee is responsible for delivery of the CCG’s overall management, to support the CCG to work efficiently, effectively and economically, ensuring clinical engagement and promoting the involvement of all member practices in the work of the CCG in securing improvements in commissioning of care and services. The committee will apply best practice in its decision making, and in particular it will:

• Ensure that decisions are based on clear and transparent criteria • Comply with CCG policy and procedures for the declaration of interests

The committee has delegated authority to commit expenditure according to the CCG scheme of delegation. Joint Committees As provided in the CCG’s Constitution, the CCG has not entered into any formal joint committees but we engage with other CCGs and partners in South Tyneside for example the Health and Wellbeing Board and a number of its sub-committees such as its Integration Board. Together with all other CCGs across the North East and Cumbria the CCG is a member of the Northern CCG Forum. The CCG has entered into joint arrangements with the CCGs in the North of England

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to determine commissioning for health gain policies and to review and approve individual funding requests, including conducting an appeals process. In accordance with the CCG’s Constitution, where the CCG has established a joint committee with another clinical commissioning group the CCG has provided details in its Scheme of Reservation and Delegation of the individual who has delegated authority to make decisions on its behalf, although the CCG retains responsibility for the decision.

Review and Assessment of Board Effectiveness and Assessment of Compliance with The UK Corporate Governance Code (2012) In reviewing and assessing the effectiveness of the Governing Body, the guidance contained within The UK Corporate Code of Governance (2012) has been further developed into a Governing Body “self-assessment” questionnaire. The guidance contained within the Code has enabled a detailed a review of Governing Body effectiveness against the following criteria – leadership, effectiveness, accountability, remuneration and relations with stakeholders on a ‘comply or explain’ basis. This self-assessment was supported by a dedicated session for the Governing Body to review Governing Body compliance with the Code. In particular, having reviewed the effectiveness of the CCG’s governance framework and arrangements in relation to The UK Corporate Code of Governance, I consider that the organisation complies with the principles and standards of best practice contained within the guidance on a ‘comply or explain’ basis. I can confirm that the arrangements in place for the discharge of statutory functions have been checked for any irregularities, and that they are legally compliant. The Clinical Commissioning Group Risk Management Framework A Risk Management Framework is in place which takes into account current guidance on risk management best practice and incorporates guidance provided by ISO 31000:2009 (formerly AZ/NZ Standard 4360:2004) and the former National Patient Safety Agency in its approach to assessing risk. The Risk Management Framework sets out the CCG’s approach to the assessment and management of clinical and non-clinical risk in fulfilment of our overall objective to commission high quality and safe services. It provides guidance for the systematic and effective management of risk. Key elements of the Risk Management Framework include:

• A clear statement of governing body and individual accountability for delivery of the framework

• Clear principles, aims and objectives of the risk management process • A clearly defined process for delivering the framework including an

implementation plan to ensure that the framework and risk management

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awareness is communicated to all staff • Details of the approach to be undertaken to assess and report risk • An agreed process for reporting, managing, analysing and learning from

adverse events supported by a “fair blame” culture and approach • Confirmation of the arrangements for reporting risk through the risk register

Risk is identified and embedded in the organisation via a number of mechanisms including the incident reporting system which identifies the risks that have already (or nearly) occurred from incidents or near misses; through our strategic planning system which ensures that all organisational objectives are rated for risks to achievement of delivery; and in our performance management system which rates all objectives for risk to delivery. In addition all Governing Body reports are assessed for equality impact. A Board Assurance Framework (BAF) has been developed and approved by the Governing Body and is actively reviewed. The Board Assurance Framework enables the Governing Body to be aware of the risks to delivery of the organisation’s principal objectives and to ensure that effective controls and assurance are in place. The Board Assurance Framework has been in place for part of the year, reflecting the establishment of the CCG as new entity from 1 April 2013. The Governing Body undertook a review of its effectiveness in March 2014 and concluded that it had not fully determined the CCG risk appetite; this will be addressed in July 2014 when the Governing Body will work with an external specialist on this issue. The CCG’s Communications and Engagement Strategy was in place in the early part of 2013/14 and is currently being refreshed to ensure its currency for 2014/15. Under this umbrella, the CCG has delivered a broad range of engagement and involvement activities, including formal consultation. One example wherein the CCG has involved the public and stakeholders in identifying risks which may impact on them is a formal consultation around significant changes in mental health services. Issues identified during this process were themed and analysed , and are being taken into account in the CCG’s forward planning around this service change. Additionally, more informally, when developing any service proposals, the CCG will carry out involvement activities to understand the public’s views on these, including perception of impact and risk. This forms part of our day to day engagement and involvement work, which is broad ranging covering a wide group of stakeholders and communities across the borough. Our Counter Fraud activity plays a key part in deterring risks to the organisation’s financial viability and probity. An annual Counter Fraud Plan is agreed by the Audit Committee which focuses on the deterrence, prevention, detection and investigation of fraud.

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The Clinical Commissioning Group Internal Control Framework A system of internal control is the set of processes and procedures in place in the clinical commissioning group to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable and not absolute assurance of effectiveness. The system of internal control has been in place in the CCG for the year ended 31 March 2014 and up to the date of approval of the Annual Report and Accounts. Information Governance The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal identifiable information. The NHS Information Governance Framework is supported by an information governance toolkit and the annual submission process provides assurances to the clinical commissioning group, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively. The CCG has an Information Governance Framework in place comprising an approved Strategy, a suite of approved policies and procedures, a programme of mandatory training, information risk management, incident management and has also adopted and implemented the Health and Social Care Information Centre’s (HSCIC), ‘Checklist for Reporting, Managing and Investigating Information Governance Serious Incidents Requiring Investigating’. The organisation has in place a standard operating procedure for the reporting of level 2 Information Governance incidents to the Information Commissioner. This procedure outlines the scope of responsibilities and details the reporting procedures to be used in the event of a data security breach. There have been no Information Governance serious breaches in year. Information Governance forms part of the agenda of the Quality, Patient Safety and Risk Committee which reports to the Board. The CCG has also appointed a Caldicott Guardian (DR Matthew Walmsley) and Senior Information Risk Owner (Dr David Hambleton). The Information Governance Toolkit has been provided by the HSCIC to support performance monitoring of progress on Information Governance in the NHS. The CCG has published the HSCIC Information Governance Toolkit Version 11 and has self-assessed as being Satisfactory. The CCG complies with its statutory duty to respond to requests for information.

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During the year the CCG received 202 requests under the Freedom of Information Act 2000 and 3 requests under the Data Protection Act 1998. All the requests were responded to within the statutory timescales.

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Pension Obligations As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments into the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations. Equality, Diversity and Human Rights Control measures are in place to ensure that all the clinical commissioning group’s obligations under equality, diversity and human rights legislation are complied with. Sustainable Development Obligations The clinical commissioning group is required to report its progress in delivering against sustainable development indicators. We are developing plans to assess risks, enhance our performance and reduce our impact, including against carbon reduction and climate change adaptation objectives. This includes establishing mechanisms to embed social and environmental sustainability across policy development, business planning and in commissioning. We will ensure the clinical commissioning group complies with its obligations under the Climate Change Act 2008, including the Adaptation Reporting power, and the Public Services (Social Value) Act 2012. We are also setting out our commitments as a socially responsible employer. Risk Assessment in Relation to Governance, Risk Management and Internal Control As Accountable Officer I have overall responsibility for:

• Ensuring the implementation of an effective risk management strategy, including effective risk management systems and internal controls

• The development of the corporate governance and assurance framework • Meeting all the statutory requirements and ensuring positive performance

towards our strategic objectives Each of the Directors of the CCG is responsible for:

• Co-ordinating operational risk in their specific areas in accordance with the Risk Management Strategy

• Ensuring that all areas of risk are assessed appropriately and action taken to implement improvements

• Ensuring that staff under their management are aware of their risk management responsibilities in relation to the Risk Management Strategy

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• Incorporating risk management as a management technique within the performance management arrangements for the organisation

The risk management process has been implemented in accordance with agreed policy by the Director of Operations supported by the Operations and Engagement Manager, with expert input from the Commissioning Support Unit. Additionally, the Chief Officer’s Scheme of Delegation clearly sets out the individual level responsibilities held at Director level in relation to risk management. The CCG’s integrated approach to risk management ensures that all risks are captured and monitored relating to quality and safeguarding, provider management, finance & QIPP and performance across the organisation. Current and potential risks are captured in the CCG’s risk register and include actions and timescales identified to minimise such risks. In accordance with local policy, the risk register is a log of risks that threaten the organisation’s success in achieving its aims and objectives and is populated through a risk assessment and evaluation process. The registers are updated on a monthly basis and are reviewed on a bi-monthly basis by the Quality, Patient Safety and Risk Committee and on a quarterly basis by the Governing Body. In terms of assurance and reporting:

• Extreme risks will be reported to the Governing Body on a quarterly basis • Extreme, High, and Moderate risks will be reported to each formal meeting of

the Quality, Patient Safety and Risk Committee • Low risks will be considered solely at team level

The risk register for South Tyneside CCG is made up of the following themed areas with identified leads (either CCG Directors or Senior Managers) as shown: Organisational – Director of Operations Quality and Safeguarding – Director of Nursing, Quality and Safety Provider Management – Director of Operations Performance – Commissioning Manager (Performance) Finance and QIPP – Chief Finance Officer South Tyneside CCG is using the Safeguard Incident and Risk Management System (SIRMS) as the tool for managing the risk register. SIRMS is a live system managed by NECS, and training on using the new system has been rolled out. Now that the first year of operating this system is completed, a review of the effectiveness of the risk management system will be undertaken in order to improve it; discussion around improvements to Governing Body reports have already taken place. Staff will also be provided with refresher training around identifying and categorising risks, as well as recording them and keeping the register up to date. CCG staff have been trained in the administration of the system by the risk management team in the Commissioning Support Unit. The operation of the risk

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management process is overseen on a monthly basis by the risk management team in the Commissioning Support Unit working closely with staff in the Director of Operations’ team. A 12 month review of the success of the operation of the risk management system will be instigated in the first quarter of 2014/15 with a view to learning from good practice and improving the system further. Risk is identified and embedded in the organisation via a number of mechanisms including a Corporate Risk Register which identifies current and prospective risks to the organisation. The Risk Register is initially reviewed by the Quality, Patient Safety and Risk Committee and the Governing Body as well as the Executive Committee. Active steps are taken to ensure that it is regularly updated and that a management action plan is developed and monitored where necessary. The responsibility for risk management had been with the Quality, Patient Safety and Risk Committee however it will be recommended to the CCG Governing Body that this focus be switched to the Audit Committee in 2014/15. In-year risks Significant corporate risks which the CCG has identified and which it has continued to mitigate through its management actions are set out below:

• Finance and QIPP (Quality, Innovation, Productivity and Prevention) delivery – risk of secondary care commissioning overspend in 2013/14 and into 2014/15

Controls systems are in place through which variances to budget are reviewed on a monthly basis and forecast outturn summaries are updated. The financial position is reported to the Governing Body, to the Executive Committee and to the Informal Audit Committee.

• Provider achievement of the Clostridium difficile target (zero tolerance) Weekly sharing of hospital acquired infection (HAI) data between the Foundation Trusts and CCG takes place to monitor the position and a joint HCAI Group with Sunderland CCG with clear systems, processes and action plans for improvement. The position is reported to the Governing Body and the Quality Patient Safety and Risk Committee.

• Safeguarding – the absence in year of a named GP for adult safeguarding within the CCG

Although there is not a statutory requirement to have a Named GP for Adult Safeguarding, the CCG is continuing a drive to recruit. In the interim a lead GP for safeguarding has been identified in each GP practice. The position is reported to the Governing Body and to the Quality Patient Safety and Risk Committee.

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• Looked After Children –there is a risk that Looked After Children (LAC) do not receive their statutory medical on time, which could result in a statutory timescale breach and the development of a care plan being delayed due to consent for medical assessment not being sent by the Local Authority to the NHS Foundation Trust in a timely manner

The importance of this has been emphasised to the Local Authority (LA) Integrated LAC team and an action plan for improvement is being put into place. The position is being monitored though the Multi Agency Looked After Partnership (MALAP) arrangements, and reported to the CCG Governing Body and to the Quality Patient Safety and Risk Committee. Future risks The current pressures on the health service are substantial, in particular the increasing demands of an ageing and growing population must be met from constrained financial resources. This will increase the pressure on current services and potential risks around delivery of performance targets whilst maintaining quality and ensuring services are safe. The introduction of the Better Care Fund in 2015/16, a single pooled budget across the CCG and local authority, designed to enable transformation in integrated health and social care, will require substantial change in the way services are delivered with an unprecedented shift in activity required away from hospital into community settings. The CCG has agreed a two year operational plan, incorporating the Better Care Fund, with a five year strategic plan in development, all supported by a financial plan. These plans demonstrate how these pressures will be managed to enable continued achievement of a balanced financial position whilst also delivering on the strategic aims of the CCG. The impact of the Better Care Fund in particular represents a significant challenge. The implementation of these plans and the schemes designed to take activity out of hospital, in 2014/15 will require close monitoring to ensure progress is made in advance of 2015/16. Risks to compliance with the CCG’s Licence No risks have been identified to compliance with the CCG’s licence. The CCG was licensed without any conditions attached to its authorisation. During 2013/2014 performance of the CCG and compliance with its licence has been assessed by the Area Team in line with NHS England’s CCG Assurance Framework and the CCG has been assured against the domains therein. Review of Economy, Efficiency and Effectiveness of the Use of Resources The CCG developed a balanced financial plan for the year 2013/14 which included holding 0.5% contingency, use of 2% of allocation on a non-recurrent basis, and delivery of 1% surplus. Within the plan the CCG also set a savings programme. Each

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meeting of the Executive Committee and of the Governing Body received a finance report detailing performance against plan. In addition, the audit committee met informally to discuss finance issues on a monthly basis. As a new organisation the CCG inherited a number of commissioning arrangements from its predecessor South Tyneside Primary Care Trust. During the period of shadow operation and as part of the transition process the CCG had the opportunity to familiarise itself with its commissioning responsibilities. As part of transition a full contract portfolio was established and the opportunity was taken to formalise a number of contractual arrangements. Throughout the commissioning round for 2013/14 all major contracts were reviewed and where possible contractual efficiencies were pursued. The CCG also undertook a review of Enhanced Services commissioning arrangements during the year, this review was supported by the Vice Chair of the CCG. The CCG also engaged with North of England Commissioning Support (NECS) Unit in ensuring that where benchmarking information was available it was used to compare CCG performance to other areas both locally and nationally and this was fed into contractual discussions and forward planning. The CCG has also supported NECS in a proposal to develop a joint working proposal to support development of sustainable savings programmes over the next five years. A review of financial planning and savings programme is included within the CCG Internal Audit work programme. As part of their annual audit, the CCG’s external auditors are required to satisfy themselves that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in the use of its resources. They do this by examining documentary evidence and through discussions with senior managers. Their audit work is made available to and reviewed by the Audit Committee.

Review of the Effectiveness of Governance, Risk Management and Internal Control As Accountable Officer, I have responsibility for reviewing the effectiveness of the system of internal control within the Clinical Commissioning Group.

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Capacity to Handle Risk As Accountable Officer I have overall responsibility for:

• Ensuring the implementation of an effective Risk Management Policy, including effective risk management systems and internal controls

• The development of the corporate governance and assurance framework • Meeting all the statutory requirements and ensuring positive performance

towards our strategic objectives. Each of the Directors of the CCG are responsible for:

• Co-ordinating operational risk in their specific areas in accordance with the Risk Management Framework

• Ensuring that all areas of risk are assessed appropriately and action taken to implement improvements

• Ensuring that staff under their management are aware of their risk management responsibilities in relation to the Risk Management Framework

• Incorporating risk management as a management technique within the performance management arrangements for the organisation

All Managers within the CCG are responsible for implementing the risk management strategy within their span of control and for ensuring that staff understand and apply the relevant policy and strategy in relation to risk management. All staff within the CCG are responsible for assisting in the implementation of the Risk Management Strategy and for highlighting any areas of risk through the incident reporting procedures, a principal means through which the CCG manages risk and learns lessons. Review of Effectiveness My review of the effectiveness of the system of internal control is informed by the work of the internal auditors and the executive managers and clinical leads within the clinical commissioning group who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Governing Body, the Audit Committee and the Quality, Patient Safety and Risk Committee and a plan to address weaknesses and ensure continuous improvement of the system is in place. This takes the form of a range of performance reports and reports that identify mitigating actions in relation to identified risks. The Board Assurance Framework itself provides me with evidence that the effectiveness of controls that manage risks to the clinical commissioning group achieving its principles objectives have been reviewed. As part of the CCGs risk management processes, an Assurance Framework has

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been in place throughout the year which provides a simple yet comprehensive method for the effective and focussed management of the principal risks and assurances to meeting and delivering the CCG’s objectives. The Assurance Framework reflects the principal risks associated with the delivery of the CCGs strategic objectives. This includes risks around the delivery of the CCGs strategic aims, financial stability including QIPP delivery, and development of effective corporate governance and risk management. The Board Assurance Framework details the key controls and assurances in place against each risk, together with any relevant action being taken to address gaps in controls and assurances where required. The Framework was further developed following its initial review by the Governing Body and is considered to be a comprehensive reflection of the internal controls in place and to provide a good level of assurance, providing evidence that action plans were in place and being delivered to meet weaknesses in controls or assurance where identified. The Board Assurance Framework is supplemented by detailed risk registers that record the full comprehensive list of all risks facing the CCG at an operational and strategic level. There have been no significant issues that have revealed deficiencies as risks have materialised. The Governing Body and Executive Committee members undertook a formal review of the effectiveness of the Governing Body and its committee sub-structures in March 2014. This review was externally facilitated and incorporated anonymous feedback from Governing Body and Executive Committee members. The outcome of this review has included a refocusing of corporate risk responsibilities and identified the need for an annual review of effectiveness of all the sub-committees, to ensure continuous improvement of the system in maintained. Following completion of the planned audit work for the financial year for the clinical commissioning group, the Head of Internal Audit issued an independent and objective opinion on the adequacy and effectiveness of the clinical commissioning group’s system of risk management, governance and internal control. The Head of Internal Audit opinion contributes to the assurances available to the Accounting Officer and the Governing Body which underpin the Governing Body’s own assessment of the effectiveness of the CCG’s system of internal control. It concluded that: The Head of Internal Audit Opinion The purpose of the Head of Internal Audit Opinion is to contribute to the assurances available to the Accounting Officer and the Board which underpin the Board’s own assessment of the effectiveness of the organisation’s system of internal control. This opinion will in turn assist the Board in the completion of its Annual Governance Statement.

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The opinion is set out as follows:

• Overall opinion • Basis for the opinion • Commentary

The overall opinion is that: On the basis of work carried out in accordance with the Annual Internal Audit Plan 2013/14, significant assurance can be given that there is a generally sound system of internal control, designed to meet the organisation’s objectives, and that controls are generally being applied consistently. The basis for forming the opinion is as follows:

• An assessment of the design and operation of the underpinning Assurance Framework and supporting processes

• An assessment of the range of individual opinions arising from risk-based audit assignments contained within internal audit risk-based plans that have been reported throughout the period. This assessment has taken account of the relative materiality of these areas and management’s progress in respect of addressing control weaknesses

There were no Internal Audit reports which provided limited or no assurance. Third Party Assurances

• Payroll – the CCG payroll service is provided by Northumbria Healthcare NHS Foundation Trust. No issues of concern have been raised during the year. The assurance letter for 2013/14 has now been issued, with all audit areas receiving an assurance level of significant with no issues of note

• North of England Commissioning Support Service (NECS) – one of the

principal risks to the CCG identified by the Audit Committee in May 2013 was receiving adequate assurances from the Commissioning Support Unit

Assurances on the operation of the support services outsourced to NECS during the period from 1 October 2013 to 31 March 2014 were provided by NHS England’s internal auditors, Deloitte LLP, via means of an ISAE 3402 report issued in May 2014. The report identified some important weaknesses within four of the 58 controls.

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The weaknesses identified were:

• Differences when NECS reconciles activity data extracted from the Secondary Uses Service (SUS) with data received directly from providers, which is preventing reconciliations being completed in line with agreed timescales. This issues also gave rise to weaknesses in preparing accurate and timely forecasts of activity data

• New employees or amendments made to existing employees were sometimes processed without being appropriately authorised in line with CCG authorised signatory lists

• Journal entries were not being periodically reviewed in line with stated controls to ensure that segregation of duties was maintained

In the report Deloitte LLP gave a qualified opinion in respect of control objective F1: Forecasts provided to customers are accurate, complete, prepared on a valid basis and provided to customers in a timely manner. This was because the work carried out by Deloitte could not confirm that forecasts were accurate, complete and prepared on a valid basis as no formal evidence was kept to show that the final forecast provided by Commissioning Finance, or any adjustments after this, were independently reviewed or checked before the figures were included within CCG Board reports. Whilst this is potentially a significant issue for the CCG it is mitigated by the processes in place between NECS and the CCG for agreeing the forecasts that will be included in the monthly reporting cycle. The CCG does not rely solely on NECS forecasts and uses local intelligence to derive the forecast position for the CCG.

• NHS Business Services Authority (BSA) – the CCG relies on the BSA for prescribing spend reporting. At the CCG Executive Committee and at the Governing Body in March 2014, it was reported that NHS BSA Information Services had written to all CCGs on 14 February 2014 to advise that ‘an error had been found in the analysis used to calculate the forecast profile used for the November PMD reports’. The November profile had been used by the CCG in the month 10 forecast outturn calculations. The profile was amended by the BSA who advised that ‘the forecast outturn for December has been calculated correctly and the profile will not change for the remainder of the financial year.’ As the error affected a number of CCGs it was agreed that the matter be escalated to the NHS England Area Team where the matter would be pursued with the BSA accordingly

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Data Quality The NECS Data Management service have processes and systems in place to assess the quality and completeness of data managed on behalf of the CCG. Data is checked at all stages of processing through CSU systems and finally on publication of reports/analysis. Data is compared against historic and planned levels to provide assurance on completeness as well as with peer organisations in the form of benchmarking analysis. Processes are in place to raise any data quality issues with providers on a monthly basis – feedback from these challenges is utilised to alter any processing routines as required. The CCG utilises contract levers where necessary to ensure high quality data is captured at source and to minimise any updating of data once received by commissioners. Reconciliation accounts for each contract highlight any discrepancies between provider and commissioner data that are then investigated and resolved. Significant validations steps are in place in all routine data processing tasks to ensure poor quality data is not made available for analysis and then subsequently used as the basis for commissioning decisions. On the basis that reports presented to the Governing Body have been through this process, the Governing Body finds the quality of data presented acceptable. Business Critical Models The CCG is aware of the quality assurance requirements in respect of business critical models contained within the recommendations in the Macpherson report. The Commissioning Support Unit holds all the business critical models that are used by the CCG. The CCG has received assurance that an appropriate framework and environment is in place to provide quality assurance of business critical models, in line with the recommendations in the Macpherson report. This assurance covers the period 1 October 2013 to March 31 2014. Further assurance has been given that all business critical models have been identified and that information relating to the quality assurance processes for those models is available to the Analytical Oversight Committee chaired by the Chief Analyst in the Department of Health, as appropriate. Data Security The CCG has published the HSCIC Information Governance Toolkit and has self-assessed as being level 2 overall compliant, which confirms the organisation’s rating as overall ‘satisfactory’ in this regard. There were no data security breaches of a serious rating identified in 2013/14. NECS as the provider of IT services to the CCG has a range of controls in place. Control objectives include: physical access, logical access, segregation of duties,

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data transmissions, data centre environmental controls, IT processing, data integrity and backups, change management procedures, network security measures, data migration, problem and incident resolution, system recovery and disaster recovery plans. Assurance is provided to the CCG on the effectiveness of these controls through the AAF01/06 (service auditor) report that Deloitte will produce for the CCG to inform this statement (Drafting note - level of assurance to be confirmed following receipt of report by CCG in due course prior to final version of AGS) Discharge of Statutory Functions During establishment, the arrangements put in place by the clinical commissioning group and explained within the Corporate Governance Framework were developed with extensive expert external legal input, to ensure compliance with the all relevant legislation. That legal advice also informed the matters reserved for Membership Body and Governing Body decision and the scheme of delegation. In light of the Harris Review, the clinical commissioning group has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative and regulations. As a result, I can confirm that the clinical commissioning group is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions. Responsibility for each duty and power has been clearly allocated to a lead Director. Directorates have confirmed that their structures provide the necessary capability and capacity to undertake all of the clinical commissioning group’s statutory duties. Conclusion It has been an exciting and challenging first year for the CCG during which we have worked hard to ensure that we have established appropriate controls within the CCG to manage risks. In reviewing this year we have made recommendations to enhance our systems and processes however I am pleased to report that there have been no significant internal control issues identified during 2013/14. Dr David Hambleton Accountable Officer 4 June 2014

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Annual accounts Independent auditor’s report to the Accountable Officer for NHS South Tyneside Clinical Commissioning Group We have audited the financial statements of NHS South Tyneside Clinical Commissioning Group for the year ended 31 March 2013 under the Audit Commission Act 1998. The financial statements comprise the Statement of Comprehensive Net Expenditure, the Statement of Financial Position, the Statement of Changes in Taxpayers’ Equity, the Statement of Cash Flows and the related notes. The financial reporting framework that has been applied in their preparation is applicable law and the accounting policies directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service in England. We have also audited the information in the Remuneration Report that is subject to audit, being:

• the table of salaries and allowances of senior managers and related narrative notes on pages 34 to 35;

• the table of pension benefits of senior managers and related narrative notes on pages 37 and 38; and

• the table of pay multiples and related narrative notes on page 36. This report is made solely to the Accountable Officer for NHS South Tyneside Clinical Commissioning Group in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 45 of the Statement of Responsibilities of Auditors and Audited Bodies published by the Audit Commission in March 2010. Respective responsibilities of the Accountable Officer and auditors As explained more fully in the Statement of Responsibilities in respect of the accounts, the Accountable Officer is responsible for overseeing the preparation of the financial statements and for being satisfied that they give a true and fair view. Our responsibility is to audit and express an opinion on the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards also require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors.

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Scope of the audit of the financial statements An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of: whether the accounting policies are appropriate to the clinical commissioning group’s circumstances and have been consistently applied and adequately disclosed; the reasonableness of significant accounting estimates made by the clinical commissioning group; and the overall presentation of the financial statements. In addition, we read all the financial and non-financial information in the annual report to identify material inconsistencies with the audited financial statements. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report. In addition, we are required to obtain evidence sufficient to give reasonable assurance that the expenditure and income reported in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them. Opinion on regularity In our opinion, in all material respects the expenditure and income have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them. Opinion on financial statements In our opinion the financial statements:

• give a true and fair view of the financial position of NHS South Tyneside Clinical Commissioning Group as at 31 March 2014 and of its net operating costs for the year then ended; and

• have been prepared properly in accordance with the accounting policies directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service in England.

Opinion on other matters In our opinion:

• the part of the Remuneration Report subject to audit has been prepared properly in accordance with the requirements directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service in England; and

• the information given in the annual report for the financial year for which the financial statements are prepared is consistent with the financial statements.

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Matters on which we report by exception We report to you if:

• in our opinion the governance statement does not reflect compliance with the Department of Health’s Guidance;

• we refer the matter to the Secretary of State under section 19 of the Audit Commission Act 1998 because we have reason to believe that the clinical commissioning group, or an officer of the clinical commissioning group, is about to make, or has made, a decision involving unlawful expenditure, or is about to take, or has taken, unlawful action likely to cause a loss or deficiency; or

• we issue a report in the public interest under section 8 of the Audit Commission Act 1998

We have nothing to report in these respects Conclusion on the CCG’s arrangements for securing economy, efficiency and effectiveness in the use of resources We are required under Section 5 of the Audit Commission Act 1998 to satisfy ourselves that NHS South Tyneside Clinical Commissioning Group has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. We have undertaken our audit in accordance with the Code of Audit Practice and, having regard to the guidance issued by the Audit Commission, we have considered the results of the following:

• our review of the annual governance statement; • the work of other relevant regulatory bodies or inspectorates, to the extent the

results of the work have an impact on our responsibilities; • our locally determined risk-based work on risks associated with establishing

NHS South Tyneside Clinical Commissioning Group as a new organisation.

As a result, we have concluded that there is the following matter to report: • NHS South Tyneside CCG uses a service organisation to carry out services

on its behalf. The CCG did not obtain assurance that control procedures at the service organisation complemented those operated by the CCG itself for the period 1 April 2013 to 30 September 2013.

• Therefore, arrangements have developed during the year but were not fully in place for the whole year for managing risks and maintaining a sound system of internal control.

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Certificate We certify that we have completed the audit of the accounts of NHS South Tyneside Clinical Commissioning Group in accordance with the requirements of the Audit Commission Act 1998 and the Code of Audit Practice issued by the Audit Commission. Cameron Waddell CPFA on behalf of Mazars LLP The Rivergreen Centre Aykley Heads Durham DH1 5TS 5 June 2014

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Financial statements Statement of comprehensive net expenditure for the year ending 31 March 2014 Note 2013/14

£000 Commissioning Other operating revenue 2 (717) Gross employee benefits 4.1 1,169 Other costs 5 229,222 Net operating costs before interest 229,674 Financing Other operating revenue 8 - Other (gains)/losses 9 - Finance costs 10 - Net operating costs for the financial year

229,674 Total Comprehensive Net Expenditure for the Financial Year

29,674

Of which: Administration Costs Gross employee benefits 4.1 1,169 Other costs 5 2,081 Other operating revenue 2 (48) Net administration costs before interest

3,202 Programme Expenditure Gross employee benefits 4.1 - Other costs 5 227,141 Other operating revenue 2 (669) Net programme expenditure before interest

226,472 Total Comprehensive Net Expenditure for the Financial Year 229,674 The notes on pages 70 to 103 form part of this statement.

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Statement of financial position as at 31 March 2014 Note 31 March 2014

£000 Non-current assets:

Property, plant and equipment 13 1

Intangible assets 14 -

Investment property 15 -

Trade and other receivables 17 -

Other financial assets 18 -

Total non-current assets 1

Current assets:

Inventories 16 -

Trade and other receivables 17 1,781

Other financial assets 18 -

Other current assets 19 -

Cash and cash equivalents 20 184

Total current assets 1,965

Non-current assets held for sale 21 -

Total current assets 1,965

Total assets 1,966

Current liabilities

Trade and other payables 23 13,359

Other financial liabilities 24 -

Other liabilities 25 -

Borrowings 26 -

Provisions 30 -

Total current liabilities 13,359

Total Assets less Current Liabilities (11,393) Non-current liabilities

Trade and other payables 23 -

Other financial liabilities 24 -

Other liabilities 25 -

Borrowings 26 -

Provisions 30 -

Total non-current liabilities -

Total Assets Employed

(11,393)

Financed by Taxpayers’ Equity

General fund (11,393)

Revaluation reserve -

Other reserves -

Charitable Reserves -

Total taxpayers' equity: (11,393)

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The notes can be found on pages 70 to105 form part of this statement. The financial statements on pages 65 to 69 were approved by the Governing Body on 7 June 2014 and signed on its behalf by: Accountable Officer Dr David Hambleton Statement of changes in taxpayers’ equity for the year ended 31 March 2014

General fund

£000 Total reserves

£000 Changes in taxpayers’ equity for 2013/14 Balance at 1 April 2013 - - Transfer of assets and liabilities from closed NHS Bodies as a result of the 1 April 2013 transition

3 3

Adjusted CCG balance at 1 April 2013 3 3 Changes in CCG taxpayers’ equity for 2013/14 Net operating costs for the financial year (229,674) (229,674) Net Recognised CCG Expenditure for the Financial Year (229,671) (229,671) Net funding 218,278 218,278 Balance at 31 March 2014 (11,393) (11,393)

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Statement of cash flow for the year ended 31 March 2014

Note 2013/14 £000

Cash Flows from Operating Activities Net operating costs for the financial year (229,674) Depreciation and amortisation 5 2 Impairments and reversals 5 - Other gains (losses) on foreign exchange - Donated assets received credited to revenue but non-cash - Government granted assets received credited to revenue but non-cash - Interest paid - Release of PFI deferred credit 16 - (Increase)/decrease in inventories - (Increase)/decrease in trade & other receivables (1,781) (Increase)/decrease in other current assets - Increase/(decrease) in trade & other payables 13,359 Increase/(decrease) in other current liabilities - Provisions utilised 30 - Increase/(decrease) in provisions 30 - Net Cash Inflow (Outflow) from Operating Activities (218,094)

Cash Flows from Investing Activities Interest received - (Payments) for property, plant and equipment - (Payments) for intangible assets - (Payments) for investments with the Department of Health - (Payments) for other financial assets - (Payments) for financial assets (LIFT) - Proceeds from disposal of assets held for sale: property, plant and equipment

-

Proceeds from disposal of assets held for sale: intangible assets - Proceeds from disposal of investments with the Department of Health - Proceeds from disposal of other financial assets - Proceeds from disposal of financial assets (LIFT) - Loans made in respect of LIFT - Loans repaid in respect of LIFT - Rental revenue - Net Cash Inflow (Outflow) from Investing Activities -

Net Cash Inflow (Outflow) before Financing (218,094)

Note: table continues on to page 69

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Note: continuation of statement of cash flow for the year ended 31 March 2014

Note 2013/14 £000

Cash Flows from Financing Activities Net funding received 218,278 Other loans received - Other loans repaid - Capital element of payments in respect of finance leases and on Statement of Financial Position PFI and LIFT

-

Capital grants and other capital receipts - Capital receipts surrendered - Net Cash Inflow (Outflow) from Financing Activities 218,278

Net Increase (Decrease) in Cash & Cash Equivalents 20 184

Cash & Cash Equivalents at the Beginning of the Financial Year - Effect of exchange rate changes on the balance of cash and cash equivalents held in foreign currencies

-

Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year

184

The financial statements on pages 65-69 were approved by the Governing Body on 4 June 2014 and signed on its behalf by: Dr David Hambleton Accountable Officer

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Notes to the financial statements 1. Accounting Policies

NHS England has directed that the financial statements of clinical commissioning groups shall meet the accounting requirements of the Manual for Accounts issued by the Department of Health. Consequently, the following financial statements have been prepared in accordance with the Manual for Accounts 2013/14 issued by the Department of Health. The accounting policies contained in the Manual for Accounts follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to clinical commissioning groups, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Manual for Accounts permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the clinical commissioning group for the purpose of giving a true and fair view has been selected. The particular policies adopted by the clinical commissioning group are described below. They have been applied consistently in dealing with items considered material in relation to the accounts.

In accordance with the Directions issued by NHS England comparative information is not provided in these Financial Statements.

1.1 Going Concern

These accounts have been prepared on the going concern basis.

Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as evidenced by inclusion of financial provision for that service in published documents.

Where a clinical commissioning group ceases to exist, it considers whether or not its services will continue to be provided (using the same assets, by another public sector entity) in determining whether to use the concept of going concern for the final set of Financial Statements. If services will continue to be provided the financial statements are prepared on the going concern basis.

1.2 Accounting Convention

These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial

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liabilities.

1.3 Acquisitions & Discontinued Operations

Activities are considered to be ‘acquired’ only if they are taken on from outside the public sector. Activities are considered to be ‘discontinued’ only if they cease entirely. They are not considered to be ‘discontinued’ if they transfer from one public sector body to another.

1.4 Movement of Assets within the Department of Health Group

Transfers as part of re-organisation fall to be accounted for by use of absorption accounting in line with the Government Financial Reporting Manual, issued by HM Treasury. The Government Financial Reporting Manual does not require retrospective adoption, so prior year transactions (which have been accounted for under merger accounting) have not been restated. Absorption accounting requires that entities account for their transactions in the period in which they took place, with no restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the gain or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is disclosed separately from operating costs.

Other transfers of assets and liabilities within the Department of Health Group are accounted for in line with IAS 20 and similarly give rise to income and expenditure entries.

For transfers of assets and liabilities from those NHS bodies that closed on 1 April 2013, HM Treasury has agreed that a modified absorption approach should be applied. For these transactions only, gains and losses are recognised in reserves rather than the Statement of Comprehensive Net Expenditure.

1.5 Charitable Funds

From 2013/14, the divergence from the Government Financial Reporting Manual that NHS Charitable Funds are not consolidated with bodies’ own returns is removed. Under the provisions of IAS 27: Consolidated & Separate Financial Statements, those Charitable Funds that fall under common control with NHS bodies are consolidated within the entities’ accounts.

1.6 Pooled Budgets

The Clinical Commissioning Group has a pooled budget arrangement with South Tyneside Council for the provision of a joint equipment store, which

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the Council hosts. The expenditure during the year contributed to the objectives of creating a single pooled budget to support the integrated service delivery and improving standards of service. The Clinical Commissioning Group accounts for its share of the income and expenditure of the pool as determined by the pooled budget agreement. The annual contribution to the pooled budget for 2013/14 was £623k.

1.7 Critical Accounting Judgements & Key Sources of Estimation Uncertainty

In the application of the Clinical Commissioning Group’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods.

1.7.1 Key Sources of Estimation Uncertainty

The following are the key estimations that management has made in the process of applying the Clinical Commissioning Group’s accounting policies that have the most significant effect on the amounts recognised in the financial statements:

Prescribing expenditure has been estimated based on ten months actual spend and two months forecast.

1.8 Revenue

Revenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value of the consideration receivable.

Where income is received for a specific activity that is to be delivered in the following year, that income is deferred.

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1.9 Employee Benefits

1.9.1 Short-term Employee Benefits

Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees, including bonuses earned but not yet taken.

The cost of leave earned but not taken by employees at the end of the period has not been recognised in the financial statements due to the immateriality of the value.

1.9.2 Retirement Benefit Costs

Past and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the Clinical Commissioning Group of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period.

For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to expenditure at the time the Clinical Commissioning Group commits itself to the retirement, regardless of the method of payment.

1.10 Other Expenses

Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable.

Expenses and liabilities in respect of grants are recognised when the Clinical Commissioning Group has a present legal or constructive obligation, which occurs when all of the conditions attached to the payment have been met.

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1.11 Property, Plant & Equipment

1.11.1 Recognition

Property, plant and equipment is capitalised if:

· It is held for use in delivering services or for administrative purposes; · It is probable that future economic benefits will flow to, or service

potential will be supplied to the Clinical Commissioning Group; · It is expected to be used for more than one financial year; · The cost of the item can be measured reliably; and, · The item has a cost of at least £5,000; or, · Collectively, a number of items have a cost of at least £5,000 and

individually have a cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or,

· Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost.

Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components are treated as separate assets and depreciated over their own useful economic lives.

1.11.2 Valuation

All property, plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. All assets are measured subsequently at fair value.

Land and buildings used for the Clinical Commissioning Group’s services or for administrative purposes are stated in the statement of financial position at their re-valued amounts, being the fair value at the date of revaluation less any impairment.

Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the end of the reporting period. Fair values are determined as follows:

· Land and non-specialised buildings – market value for existing use; and, · Specialised buildings – depreciated replacement cost.

HM Treasury has adopted a standard approach to depreciated replacement

cost valuations based on modern equivalent assets and, where it would

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meet the location requirements of the service being provided, an alternative site can be valued.

Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. Assets are re-valued and depreciation commences when they are brought into use.

Fixtures and equipment are carried at depreciated historic cost as this is not considered to be materially different from fair value.

An increase arising on revaluation is taken to the revaluation reserve except when it reverses an impairment for the same asset previously recognised in expenditure, in which case it is credited to expenditure to the extent of the decrease previously charged there. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Gains and losses recognised in the revaluation reserve are reported as other comprehensive income in the Statement of Comprehensive Net Expenditure.

1.12 Intangible Assets

1.12.1 Recognition

Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the Clinical Commissioning Group’s business or which arise from contractual or other legal rights. They are recognised only:

· When it is probable that future economic benefits will flow to, or service potential be provided to, the Clinical Commissioning Group;

· Where the cost of the asset can be measured reliably; and, · Where the cost is at least £5,000.

Following the demise of Primary Care Trusts, there were no intangible

assets transferred to the Clinical Commissioning Group at the start of the financial year 2013/14.

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1.13 Depreciation, Amortisation & Impairments

Freehold land, properties under construction, and assets held for sale are not depreciated.

Otherwise, depreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment and intangible non-current assets, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the Clinical Commissioning Group expects to obtain economic benefits or service potential from the asset. This is specific to the Clinical Commissioning Group and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are depreciated over their estimated useful lives.

At each reporting period end, the Clinical Commissioning Group checks whether there is any indication that any of its tangible or intangible non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets not yet available for use are tested for impairment annually.

A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Where an impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve.

1.14 Donated Assets

Following the demise of Primary Care Trusts, there were no donated assets transferred to the Clinical Commissioning Group at the start of the financial year 2013/14.

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1.15 Government Grants

Following the demise of Primary Care Trusts, there were no government grants transferred to the Clinical Commissioning Group at the start of the financial year 2013/14.

1.16 Non-current Assets Held For Sale

Following the demise of Primary Care Trusts, there were no non-current assets held for sale transferred to the Clinical Commissioning Group at the start of the financial year 2013/14.

1.17 Leases

Leases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases are classified as operating leases.

1.17.1 The Clinical Commissioning Group as Lessee

Property, plant and equipment held under finance leases are initially recognised, at the inception of the lease, at fair value or, if lower, at the present value of the minimum lease payments, with a matching liability for the lease obligation to the lessor. Lease payments are apportioned between finance charges and reduction of the lease obligation so as to achieve a constant rate on interest on the remaining balance of the liability. Finance charges are recognised in calculating the Clinical Commissioning Group’s surplus/deficit.

Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term.

Details of Leases held by the Clinical Commissioning Group can be found in the Operating Lease Note (Note12).

Contingent rentals are recognised as an expense in the period in which they are incurred.

Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are operating or finance leases.

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1.18 Private Finance Initiative Transactions

Following the demise of Primary Care Trusts, there were no private finance initiatives transferred to the Clinical Commissioning Group at the start of the financial year 2013/14.

1.19 Inventories

Inventories are valued at the lower of cost and net realisable value using the first-in first-out cost formula. This is considered to be a reasonable approximation to fair value due to the high turnover of stocks.

The Clinical Commissioning Group does not hold any stock as at 31 March 2014.

1.20 Cash & Cash Equivalents

Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value.

In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the Clinical Commissioning Group’s cash management.

1.21 Provisions

Provisions are recognised when the Clinical Commissioning Group has a present legal or constructive obligation as a result of a past event, it is probable that the Clinical Commissioning Group will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. Where a provision is measured using the cash flows estimated to settle the obligation, its carrying amount is the present value of those cash flows using HM Treasury’s discount rate as follows:

· Timing of cash flows (0 to 5 years inclusive): Minus 1.90% · Timing of cash flows (6 to 10 years inclusive): Minus 0.65% · Timing of cash flows (over 10 years): Plus 2.20% · All employee early departures: 1.80%

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When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured reliably.

A restructuring provision is recognised when the Clinical Commissioning Group has developed a detailed formal plan for the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it. The measurement of a restructuring provision includes only the direct expenditures arising from the restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with on-going activities of the entity.

The accounting arrangements for balances transferred from predecessor PCTs ("legacy" balances) are determined by the Accounts Direction issued by NHS England on 12 February 2014. The Accounts Directions state that the only legacy balances to be accounted for by the Clinical Commissioning Group are in respect of property, plant and equipment (and related liabilities) and inventories. All other legacy balances in respect of assets or liabilities arising from transactions or delivery of care prior to 31 March 2013 are accounted for by NHS England. The Clinical Commissioning Group's arrangements in respect of settling NHS Continuing Healthcare claims are disclosed in note 30 to these financial statements.

1.22 Clinical Negligence Costs

The NHS Litigation Authority operates a risk pooling scheme under which the Clinical Commissioning Group pays an annual contribution to the NHS Litigation Authority which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although the NHS Litigation Authority is administratively responsible for all clinical negligence cases the legal liability remains with the Clinical Commissioning Group.

1.23 Non-clinical Risk Pooling

The Clinical Commissioning Group participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the Clinical Commissioning Group pays an annual contribution to the NHS Litigation Authority and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due.

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1.24 Carbon Reduction Commitment Scheme

Carbon Reduction Commitment and similar allowances are accounted for as government grant funded intangible assets if they are not expected to be realised within twelve months, and otherwise as other current assets. They are valued at open market value. As the Clinical Commissioning Group makes emissions, a provision is recognised with an offsetting transfer from deferred income. The provision is settled on surrender of the allowances. The asset, provision and deferred income amounts are valued at fair value at the end of the reporting period.

The Clinical Commissioning Group do not have any EU Emissions Trading scheme allowances as at 31 March 2014 and therefore this policy does not impact on this set of accounts.

1.25 Contingencies

A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the Clinical Commissioning Group, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is remote.

A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the Clinical Commissioning Group. A contingent asset is disclosed where an inflow of economic benefits is probable.

Where the time value of money is material, contingencies are disclosed at their present value.

The Clinical Commissioning Group has no contingencies as at 31 March 2014.

1.26 Financial Assets

Financial assets are recognised when the Clinical Commissioning Group becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred.

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Financial assets are classified into the following categories:

· Financial assets at fair value through profit and loss; · Held to maturity investments; · Available for sale financial assets; and, · Loans and receivables.

The classification depends on the nature and purpose of the financial

assets and is determined at the time of initial recognition.

1.26.1 Financial Assets at Fair Value Through Profit and Loss

Embedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whose separate value cannot be ascertained, are treated as financial assets at fair value through profit and loss. They are held at fair value, with any resultant gain or loss recognised in calculating the Clinical Commissioning Group’s surplus or deficit for the year. The net gain or loss incorporates any interest earned on the financial asset.

1.26.2 Held to Maturity Assets

Held to maturity investments are non-derivative financial assets with fixed or determinable payments and fixed maturity, and there is a positive intention and ability to hold to maturity. After initial recognition, they are held at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method.

1.26.3 Available For Sale Financial Assets

Available for sale financial assets are non-derivative financial assets that are designated as available for sale or that do not fall within any of the other three financial asset classifications. They are measured at fair value with changes in value taken to the revaluation reserve, with the exception of impairment losses. Accumulated gains or losses are recycled to surplus/deficit on de-recognition.

1.26.4 Loans & Receivables

Loans and receivables are non-derivative financial assets with fixed or

determinable payments which are not quoted in an active market. After initial recognition, they are measured at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method.

Fair value is determined by reference to quoted market prices where possible, otherwise by valuation techniques.

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The effective interest rate is the rate that exactly discounts estimated future cash receipts through the expected life of the financial asset, to the initial fair value of the financial asset.

At the end of the reporting period, the Clinical Commissioning Group assesses whether any financial assets, other than those held at ‘fair value through profit and loss’ are impaired. Financial assets are impaired and impairment losses recognised if there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset.

For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset’s carrying amount and the present value of the revised future cash flows discounted at the asset’s original effective interest rate. The loss is recognised in expenditure and the carrying amount of the asset is reduced through a provision for impairment of receivables.

If, in a subsequent period, the amount of the impairment loss decreases and the decrease can be related objectively to an event occurring after the impairment was recognised, the previously recognised impairment loss is reversed through expenditure to the extent that the carrying amount of the receivable at the date of the impairment is reversed does not exceed what the amortised cost would have been had the impairment not been recognised.

1.27 Financial Liabilities

Financial liabilities are recognised on the statement of financial position when the Clinical Commissioning Group becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired.

Loans from the Department of Health are recognised at historical cost. Otherwise, financial liabilities are initially recognised at fair value.

1.27.1 Financial Guarantee Contract Liabilities

Financial guarantee contract liabilities are subsequently measured at the higher of:

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· The premium received (or imputed) for entering into the guarantee less cumulative amortisation; and,

· The amount of the obligation under the contract, as determined in accordance with IAS 37: Provisions, Contingent Liabilities and Contingent Assets.

1.27.2 Financial Liabilities at Fair Value Through Profit and Loss

Embedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whose separate value cannot be ascertained, are treated as financial liabilities at fair value through profit and loss. They are held at fair value, with any resultant gain or loss recognised in the Clinical Commissioning Group’s surplus/deficit. The net gain or loss incorporates any interest payable on the financial liability.

1.27.3 Other Financial Liabilities

After initial recognition, all other financial liabilities are measured at amortised cost using the effective interest method, except for loans from Department of Health, which are carried at historic cost. The effective interest rate is the rate that exactly discounts estimated future cash payments through the life of the asset, to the net carrying amount of the financial liability. Interest is recognised using the effective interest method.

1.28 Value Added Tax

Most of the activities of the Clinical Commissioning Group are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.

1.29 Foreign Currencies

The Clinical Commissioning Group’s functional currency and presentational currency is sterling. Transactions denominated in a foreign currency are translated into sterling at the exchange rate ruling on the dates of the transactions. At the end of the reporting period, monetary items denominated in foreign currencies are retranslated at the spot exchange rate on 31 March. Resulting exchange gains and losses for either of these are recognised in the Clinical Commissioning Group’s surplus/deficit in the period in which they arise.

86

The Clinical Commissioning Group has no foreign currency transactions as at 31 March 2014.

1.30 Third Party Assets

Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the Clinical Commissioning Group has no beneficial interest in them.

The Clinical Commissioning Group has no third party assets as at 31 March 2014.

1.31 Losses & Special Payments

Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled.

Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had the Clinical Commissioning Group not been bearing its own risks (with insurance premiums then being included as normal revenue expenditure).

The Clinical Commissioning Group has not made any losses and special payments during 2013/14.

1.32 Subsidiaries

Material entities over which the Clinical Commissioning Group has the power to exercise control so as to obtain economic or other benefits are classified as subsidiaries and are consolidated. Their income and expenses; gains and losses; assets, liabilities and reserves; and cash flows are consolidated in full into the appropriate financial statement lines. Appropriate adjustments are made on consolidation where the subsidiary’s accounting policies are not aligned with the Clinical Commissioning Group or where the subsidiary’s accounting date is not co-terminus.

Subsidiaries that are classified as ‘held for sale’ are measured at the lower of their carrying amount or ‘fair value less costs to sell’.

The Clinical Commissioning Group has no subsidiary arrangement as at 31 March 2014.

87

1.33 Associates

Material entities over which the Clinical Commissioning Group has the

power to exercise significant influence so as to obtain economic or other benefits are classified as associates and are recognised in the Clinical Commissioning Group’s accounts using the equity method. The investment is recognised initially at cost and is adjusted subsequently to reflect the Clinical Commissioning Group’s share of the entity’s profit/loss and other gains/losses. It is also reduced when any distribution is received by the Clinical Commissioning Group from the entity.

Joint ventures that are classified as ‘held for sale’ are measured at the lower of their carrying amount or ‘fair value less costs to sell’.

The Clinical Commissioning Group has no associate arrangement as at 31 March 2014.

1.34 Joint Ventures

Material entities over which the Clinical Commissioning Group has joint control with one or more other parties so as to obtain economic or other benefits are classified as joint ventures. Joint ventures are accounted for using the equity method.

Joint ventures that are classified as ‘held for sale’ are measured at the lower of their carrying amount or ‘fair value less costs to sell’.

The Clinical Commissioning Group has no joint venture arrangement as at 31 March 2014.

1.35 Joint Operations

Joint operations are activities undertaken by the Clinical Commissioning Group in conjunction with one or more other parties but which are not performed through a separate entity. The Clinical Commissioning Group records its share of the income and expenditure; gains and losses; assets and liabilities; and cash flows.

The Clinical Commissioning Group has no joint operations arrangement as at 31 March 2014.

88

1.36 Research & Development

Research and development expenditure is charged in the year in which it is incurred, except insofar as development expenditure relates to a clearly defined project and the benefits of it can reasonably be regarded as assured. Expenditure so deferred is limited to the value of future benefits expected and is amortised through the Statement of Comprehensive Net Expenditure on a systematic basis over the period expected to benefit from the project. It should be re-valued on the basis of current cost. The amortisation is calculated on the same basis as depreciation.

1.37 Accounting Standards That Have Been Issued But Have Not Yet Been Adopted

The Government Financial Reporting Manual does not require the following Standards and Interpretations to be applied in 2013/14, all of which are subject to consultation:

· IAS 27: Separate Financial Statements · IAS 28: Investments in Associates & Joint Ventures · IAS 32: Financial Instruments – Presentation (amendment) · IFRS 9: Financial Instruments · IFRS 10: Consolidated Financial Statements · IFRS 11: Joint Arrangements · IFRS 12: Disclosure of Interests in Other Entities · IFRS 13: Fair Value Measurement

The application of the Standards as revised would not have a material

impact on the accounts for 2013/14, were they applied in that year.

89

2. Other Operating Revenue

2013/14

2013/14

2013/14

Total

Admin

Programme

£000

£000

£000

Charitable and other contributions to revenue expenditure: non-NHS 41 41 -

Non-patient care services to other bodies 665 - 665 Other revenue 11 7 4 Total other operating revenue 717 48 669

Admin revenue is revenue received that is not directly attributable to the provision of healthcare or healthcare services. Revenue in this note does not include cash received from NHS England, which is drawn down directly into the bank account of the Clinical Commissioning Group and credited to the General Fund. 3. Revenue

Revenue is totally from the supply of services. The Clinical Commissioning Group receives no revenue from the sale of goods.

4. Employee benefits and staff numbers

4.1 Employee benefits

2013/14

Total

Admin

Total Permanent Employees

Total Permanent Employees

£000

£000

£000

£000

Employee Benefits Salaries and wages 960

960

960

960

Social security costs 89

89

89

89 Employer Contributions to NHS

Pension scheme 120

120

120

120 CCG employee benefits

expenditure 1,169

1,169

1,169

1,169

The Director of Nursing and Quality for the Clinical Commissioning Group is employed by NHS Sunderland Clinical Commissioning Group with 0.4 WTE being recharged and included in the numbers in the table above.

90

4.2 Average number of people employed

2013/14

Total

Permanently employed

Other

Number

Number

Number

Total 19

19

-

There are no whole time equivalent people engaged on capital projects. 4.3 Staff sickness absence and ill health retirements

2013/14

Number

Total Days Lost

88 Total Staff Years

21

Average working Days Lost

4

There were no ill-health retirement costs during 2013/14. 4.4 Exit packages agreed in the financial year

The Clinical Commissioning Group had no exit packages during 2013/14. 4.5 Pension costs Past and present employees are covered by the provisions of the NHS Pension Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/Pensions. The Scheme is an unfunded, defined benefit scheme that covers NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The Scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the Scheme is accounted for as if it were a defined contribution scheme: the cost to the Clinical Commissioning Group of participating in the Scheme is taken as equal to the contributions payable to the Scheme for the accounting period. The Scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an accounting valuation every year. An outline of these follows:

91

4.5.1 Full actuarial (funding) valuation The purpose of this valuation is to assess the level of liability in respect of the benefits due under the Scheme (taking into account its recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme members. The last such valuation, which determined current contribution rates was undertaken as at 31 March 2004 and covered the period from 1 April 1999 to that date. The conclusion from the 2004 valuation was that the Scheme had accumulated a notional deficit of £3.3 billion against the notional assets as at 31 March 2004. In order to defray the costs of benefits, employers pay contributions at 14% of Pensionable pay and most employees had up to April 2008 paid 6%, with manual staff paying 5%. Following the full actuarial review by the Government Actuary undertaken as at 31 March 2004, and after consideration of changes to the NHS Pension Scheme taking effect from 1 April 2008, his Valuation report recommended that employer contributions could continue at the existing rate of 14% of Pensionable pay, from 1 April 2008, following the introduction of employee contributions on a tiered scale from 5% up to 8.5% of their Pensionable pay depending on total earnings. On advice from the scheme actuary, scheme contributions may be varied from time to time to reflect changes in the scheme’s liabilities. 4.5.2 Accounting valuation A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period by updating the results of the full actuarial valuation. Between the full actuarial valuations at a two-year midpoint, a full and detailed member data-set is provided to the scheme actuary. At this point the assumptions regarding the composition of the scheme membership are updated to allow the scheme liability to be valued. The valuation of the scheme liability as at 31 March 2011 is based on detailed membership data as at 31 March 2008 (the latest midpoint) updated to 31 March 2011 with summary global member and accounting data. The latest assessment of the liabilities of the Scheme is contained in the scheme actuary report, which forms part of the annual NHS Pension Scheme (England and Wales) Resource Account, published annually. These accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery Office.

92

4.5.3 Scheme Provisions

The NHS Pension Scheme provides defined benefits, which are summarised below. This list is an illustrative guide only, and is not intended to detail all the benefits provided by the Scheme or the specific conditions that must be met before these benefits can be obtained:

• The Scheme is a “final salary” scheme. Annual pensions are normally based on 1/80th for the 1995 section and of the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of reckonable pay per year of membership. Members who are practitioners as defined by the Scheme Regulations have their annual pensions based upon total pensionable earnings over the relevant pensionable service

• With effect from 1 April 2008 members can choose to give up some of their annual pension for an additional tax free lump sum, up to a maximum amount permitted under HM Revenue & Customs rules. This new provision is known as “pension commutation”

• Annual increases are applied to pension payments at rates defined by the Pensions (Increase) Act 1971, and are based on changes in retail prices in the twelve months ending 30 September in the previous calendar year

• Early payment of a pension, with enhancement, is available to members of the Scheme who are permanently incapable of fulfilling their duties effectively through illness or infirmity. A death gratuity of twice final year’s pensionable pay for death in service, and five times their annual pension for death after retirement is payable

• For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to the statement of comprehensive net expenditure at the time the Clinical Commissioning Group commits itself to the retirement, regardless of the method of payment

• Members can purchase additional service in the Scheme and contribute to money purchase AVC’s run by the Scheme’s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers.

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5. Operating expenses

2013/14

2013/14

2013/14

Total

Admin

Programme

£000

£000

£000

Gross employee benefits

Employee benefits excluding Governing Body members 738

738

-

Executive Governing Body members 431

431

- Total gross employee benefits 1,169

1,169

-

Other costs Services from other CCGs and NHS England 1,621

1,619

2

Services from foundation trusts 170,669

-

170,669 Services from other NHS trusts 185

-

185

Purchase of healthcare from non-NHS bodies 25,737

-

25,737 Chair and lay membership body and Governing Body members 108

108

-

Supplies and services – clinical 3

-

3 Supplies and services – general 39

39

-

Consultancy services 1

1

- Establishment 57

27

30

Transport 3

2

1 Premises 2,731

83

2,648

Depreciation 2

2

- External Audit fees 72

72

-

Other auditor’s remuneration -

-

- Internal audit services 30

30

-

Prescribing costs 27,611

-

27,611 GPMS/APMS and PCTMS 243

-

243

Other professional fees excl. audit 89

77

12 Clinical negligence 5

5

-

Education and training 16

16

- Total other costs 229,222

2,081

227,141

Total operating expenses 230,391

3,250

227,141

Admin expenditure is expenditure incurred that is not a direct payment for the provision of healthcare or healthcare services. The external auditor of the Clinical Commissioning Group is Mazars LLP. The audit fee for 2013/14, excluding VAT, was £66,000. During the year a rebate of £6,000 was received from the Audit Commission.

94

6.1 Better Payment Practice Code Measure of compliance 2013/14

2013/14

Number

£000

Non-NHS Payables Total Non-NHS Trade invoices paid in the Year 3,307

26,109

Total Non-NHS Trade Invoices paid within target 3,177

25,877 Percentage of Non-NHS Trade invoices paid within target 96.07%

99.11%

NHS Payables

Total NHS Trade Invoices Paid in the Year 1,021

183,505 Total NHS Trade Invoices Paid within target 991

183,016

Percentage of NHS Trade Invoices paid within target 97.06%

99.73%

The Better Payment Practice Code requires the Clinical Commissioning Group to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later.

6.2 The Late Payment of Commercial Debts (Interest) Act 1998

In 2013/14 the Clinical Commissioning Group had no late payment of commercial debts.

7. Income Generation Activities

The Clinical Commissioning Group did not undertake any income generation activities in 2013/14.

8. Investment revenue The Clinical Commissioning Group does not have any investment revenue as at 31 March 2014. 9. Other gains and losses

The Clinical Commissioning Group does not have any other gains and losses as at 31 March 2014.

10. Finance costs The Clinical Commissioning Group does not have any finance costs as at 31 March 2014.

11. Net gain/(loss) on transfer by absorption The Clinical Commissioning Group has no net gain/(loss) on transfer by absorption as at 31 March 2014.

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12. Operating Leases

12.1 As lessee The significant operating leases represented in the figure below are in relation to NHS Property Services and Community Health Partnership. In addition to the lease for the Clinical Commissioning Group headquarters, this figure also includes leases for properties which the Clinical Commissioning Group are deemed to be responsible for but do not occupy.

The Clinical Commissioning Group occupies property owned and managed by Community Health Partnerships Ltd and NHS Property Services Ltd. For 2013/14, a transitional occupancy rent based on annual property cost allocations was agreed. This is reflected in Note 12.1.1.

While our arrangements with Community Health Partnerships Ltd and NHS Property Services Ltd fall within the definition of operating leases, the rental charge for future years has not yet been agreed.

Consequently, this note includes only the known future minimum lease payments from other rental arrangements.

96

12.1.1 Payments recognised as an Expense 2013/14

Buildings Other Total

£000 £000 £000

Payments recognised as an expense Minimum lease payments 2,728 12 2,740

Contingent rents - - - Sub-lease payments - - - Total 2,728

12

2,740

12.1.2 Future minimum lease payments 2013/14

Buildings Other Total

£000 £000 £000

Payable:

No later than one year - 2 2 Between one and five years - - - After five years - - - Total -

2

2

12.2 As lessor The Clinical Commissioning Group has no lessor arrangement. 13. Property, plant and equipment

2013/14

Transport equipment

Total

£000

£000

Cost or valuation at 1 April 2013

-

-

Transfer of assets from closed NHS bodies as a result of the 1 April 2013 transition

3

3

Adjusted Cost or valuation at 1 April 2013

3

3

At 31 March 2014

3

3

Depreciation 1 April 2013

-

-

Charged during the year

2

2 At 31 March 2014

2

2

Net Book Value at 31 March 2014

1

1

97

This asset has been purchased and is owned by the Clinical Commissioning Group.

Revaluation Reserve Balance for Property, Plant & Equipment

The Clinical Commissioning Group had no Revaluation Reserve balance as at 31 March 2014. 13.1 Additions to assets under construction The Clinical Commissioning Group does not have any assets under construction as at 31 March 2014.

13.2 Donated assets The Clinical Commissioning Group does not have any donated assets as at 31 March 2014.

13.3 Government granted assets The Clinical Commissioning Group does not have any government granted assets as at 31 March 2014.

13.4 Property revaluation

The Clinical Commissioning Group does not have any property revaluation as at 31 March 2014.

13.5 Compensation from third parties The Clinical Commissioning Group does not have any compensation from third parties as at 31 March 2014.

13.6 Write downs to recoverable amount The Clinical Commissioning Group does not have any assets which have been written down as at 31 March 2014.

13.7 Temporarily idle assets

The Clinical Commissioning Group had no temporarily idle assets as at 31 March 2014.

13.8 Cost or valuation of fully depreciated assets

The Clinical Commissioning Group had no fully depreciated assets.

98

13.9 Economic lives

Minimum Life

(years)

Minimum Life

(years) Transport equipment

1

1

14. Intangible non-current assets

The Clinical Commissioning Group had no intangible assets as at 31 March 2014. 14.1 Donated assets The Clinical Commissioning Group does not have any donated assets as at 31 March 2014.

14.2 Government granted assets The Clinical Commissioning Group does not have any government granted assets as at 31 March 2014.

14.3 Revaluation

The Clinical Commissioning Group does not have any intangible asset revaluation as at 31 March 2014.

14.4 Compensation from third parties The Clinical Commissioning Group does not have any compensation from third parties as at 31 March 2014.

14.5 Write downs to recoverable amount The Clinical Commissioning Group does not have any assets which have been written down as at 31 March 2014.

14.6 Non-capitalised assets The Clinical Commissioning Group does not have any non-capitalised assets as at 31 March 2014.

14.7 Temporarily idle assets

The Clinical Commissioning Group had no temporarily idle assets as at 31 March 2014.

99

14.8 Cost or valuation of fully amortised assets

The Clinical Commissioning Group had no fully depreciated assets as at 31 March 2014.

15. Investment property

The Clinical Commissioning Group had no investment property as at 31 March 2014. 16. Inventories

The Clinical Commissioning Group had no inventories as at 31 March 2014. 17. Trade and other receivables

Current

2013/14

£000

NHS receivables: Revenue 451

NHS prepayments and accrued income 641 Non-NHS receivables: Revenue 684 Non-NHS prepayments and accrued income 2 VAT 3 Total 1,781

Total current 1,781

The Clinical Commissioning Group has no non-current receivables as at 31 March 2014.

The majority of trade is with NHS England. As NHS England is funded by Government to provide funding to Clinical Commissioning Groups to commission services, no credit scoring of them is considered necessary. 17.1 Receivables past their due date but not impaired

2013/14

£000

By up to three months

1 Total

1

The Clinical Commissioning Group did not hold any collateral against receivables outstanding at 31 March 2014. 17.2 Provision for impairment of receivables

100

The Clinical Commissioning Group did not make any provision for impairment of receivables during 2013/14.

18. Other financial assets The Clinical Commissioning Group had no other financial assets as at 31 March 2014.

19. Other current assets The Clinical Commissioning Group had no other current assets as at 31 March 2014. 20. Cash and cash equivalents

2013/14

£000

Balance at 1 April 2013 -

Net change in year 184 Balance at 31 March 2014 184

Made up of: Cash with the Government Banking Service 184

Cash and cash equivalents as in statement of financial position 184

Bank overdraft: Government Banking Service - Total bank overdrafts included in borrowings in statement of

financial position -

Balance at 31 March 2014 184

21. Non-current assets held for sale

The Clinical Commissioning Group had no non-current assets held for sale as at 31 March 2014. 22. Analysis of impairments and reversals The Clinical Commissioning Group had no impairments or reversals of impairments recognised in expenditure during 2013/14.

101

23. Trade and other payables Current

2013/14

£000

NHS payables: revenue 148

NHS accruals and deferred income 4,776 Non-NHS payables: revenue 3,631 Non-NHS accruals and deferred income 4,656 Other payables 148 Total 13,359

Total payables (current and non-current) 13,359

24. Other financial liabilities

25. Other liabilities The Clinical Commissioning Group had no other liabilities as at 31 March 2014.

26. Borrowings The Clinical Commissioning Group had no Borrowings as at 31st March 2014. 27. Private finance initiative, LIFT and other service concession

arrangements The Clinical Commissioning Group had no PFI, LIFT or other service concession arrangements that were excluded from the SoFP as at 31 March 2014.

28. Finance lease obligations

The Clinical Commissioning Group had no finance lease obligations as at 31 March 2014.

29 Finance lease receivables The Clinical Commissioning Group had no finance lease receivables as at 31 March 2014.

30. Provisions

Under the Accounts Direction issued by NHS England on 12 February 2014, NHS England is responsible for accounting for liabilities relating to NHS Continuing

102

Healthcare claims relating to periods of care before establishment of the Clinical Commissioning Group. However, the legal liability remains with the Clinical Commissioning Group. The total value of legacy NHS Continuing Healthcare provisions accounted for by NHS England on behalf of this Clinical Commissioning Group at 31st March 2014 is £2,353k.

31. Contingencies

The Clinical Commissioning Group had no contingencies as at 31 March 2014.

32. Commitments

32.1 Capital commitments The Clinical Commissioning Group had no capital commitments not otherwise included in these financial statements as at 31 March 2014. 32.2 Other financial commitments

The Clinical Commissioning Group had no non-cancellable contracts (which were not leases, PFI contracts or other service concession arrangements) as at 31 March 2014. 33. Financial instruments

33.1 Financial risk management Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities.

Because the Clinical Commissioning Group is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The Clinical Commissioning Group has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the Clinical Commissioning Group in undertaking its activities.

Treasury management operations are carried out by the finance department, within parameters defined formally within the Clinical Commissioning Group’s standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the Clinical Commissioning Group’s internal auditors. 33.1.1 Currency risk

103

The Clinical Commissioning Group is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The Clinical Commissioning Group has no overseas operations. The Clinical Commissioning Group therefore has low exposure to currency rate fluctuations.

33.1.2 Interest rate risk

The Clinical Commissioning Group borrows from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings are for 1 to 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The Clinical Commissioning Group therefore has low exposure to interest rate fluctuations.

33.1.3 Credit risk

Because the majority of the Clinical Commissioning Group’s revenue comes parliamentary funding, the Clinical Commissioning Group has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other receivables note.

33.1.3 Liquidity risk

The Clinical Commissioning Group is required to operate within revenue and capital resource limits agreed with NHS England, which are financed from resources voted annually by Parliament. The Clinical Commissioning Group draws down cash to cover expenditure, from NHS England, as the need arises. The Clinical Commissioning Group is not, therefore, exposed to significant liquidity risks.

33.2 Financial assets

At ‘fair value

through profit and loss’

Loans and Receivables

Total

2013/14 2013/14 2013/14

£000

£000

£000

Receivables:

· NHS

-

451

451 · Non-NHS

-

684

684

Cash at bank and in hand

-

184

184 Total at 31 March 2014

-

1,319

1,319

104

33.3. Financial liabilities

At ‘fair value

through profit and loss’

Other Total

2013/14 2013/14 2013/14

£000

£000

£000

Payables:

· NHS

-

4,924

4,924 · Non-NHS

-

8,287

8,287

Total at 31 March 2014

-

13,211

13,211

34. Operating segments

The Clinical Commissioning Group consider they have only one segment: commissioning of healthcare services.

35. Pooled budgets

The Clinical Commissioning Group had entered into a pooled budget with South Tyneside Council. The pool is hosted by South Tyneside Council. Under the arrangement funds are pooled under Section 75 of the NHS Act 2006 for the provision of a joint equipment store. The Clinical Commissioning Group accounts for its share of the income and expenditure of the pool as determined by the pooled budget agreement. The annual contribution to the pooled budget for 2013/14 was £623,000.

36. NHS Lift investments

The Clinical Commissioning Group had no NHS Lift investments as at 31 March 2014.

105

37. Intra-government and other balances

Current Receivables

Current Payables

2013/14 2013/14

£000

£000

Balances with: · Other Central Government bodies

2

- · Local Authorities

659

1,533

Balances with NHS bodies:

· NHS bodies outside the Departmental Group

391

2 · NHS Trusts and Foundation Trusts

702

4,922

Total of balances with NHS bodies:

1,093

4,924

· Public corporations and trading funds

-

- · Bodies external to Government

27

6,902

Total balances at 31 March 2014

1,781

13,359

106

38. Related party transactions

Details of related party transactions with individuals are as follows: Member Related Party Payments to

Related Party Receipts from Related Party

Amounts owed to Related Party

Amounts due from Related Party

£000 £000 £000 £000 Dr Matthew Walmsley

Marsden Road Health Centre 13 - - -

Dr Tarquin Cross Northumbria Healthcare NHS Foundation Trust

45 - 89 -

Dr David Hambleton *

NHS North of England CSU 1,813 (112) - (192)

Dr Funmi Nixon Westoe Surgery 22 - - -

Dr Jon Tose Central Surgery 94 - - -

Dr James Gordon Trinity Medical Group 33 - - -

Dr James Gordon Imeary Street Surgery 21 - - -


Ravensworth Surgery 35 - - -

Ms Ros Whitehead Ellison View Surgery 31 - - -

2,107 (112) 89 (192)

* Dr David Hambleton's wife is employed by NHS North of England Commissioning Support Unit.

The Department of Health is regarded as a related party. During the year the Clinical Commissioning Group has had a significant number of material transactions with entities for which the Department is regarded as the parent Department. For example: • NHS England (including North of England Commissioning Support Unit); • NHS Foundation Trusts (including City Hospitals Sunderland NHS Foundation Trust, County Durham and Darlington NHS Foundation Trust, Gateshead Health NHS Foundation Trust, North East Ambulance Service NHS Foundation Trust, Northumbria Healthcare NHS Foundation Trust, Northumberland, Tyne and Wear NHS Foundation Trust, South Tees Hospitals NHS Foundation Trust, South Tyneside NHS Foundation Trust, The Newcastle Upon Tyne Hospitals NHS Foundation Trust) • NHS Trusts; • NHS Litigation Authority; and, • NHS Business Services Authority.

107

In addition, the Clinical Commissioning Group has had a number of material transactions with other Government departments and other central and local government bodies. Most of these transactions have been with South Tyneside Council. 39. Events after the end of the reporting period

There are no post balance sheet events which will have a material effect on the financial statements of the Clinical Commissioning Group or consolidated group. These statements were authorised for issue by Dr David Hambleton on 28th May 2014.

40. Losses and special payments

40.1 Losses

The Clinical Commissioning Group had no losses or special payments cases during 2013/14.

41. Third party assets

The Clinical Commissioning Group had no third party assets as at 31 March 2014.

108

42. Financial performance targets

Clinical Commissioning Groups have a number of financial duties under the National Health Service Act 2006 (as amended). The Clinical Commissioning Group’s performance against those duties was as follows:

2013/14

Maximum Performance Duty

£'000 £'000 Achieved?

223H(1) Expenditure not to exceed income 230,292 229,674 Yes

223I(2) Capital resource use does not exceed the amount specified in Directions - - -

223I(3) Revenue resource use does not exceed the amount specified in Directions 230,292 229,674 Yes

223J(1)

Capital resource use on specified matter(s) does not exceed the amount specified in Directions

- - -

223J(2)

Revenue resource use on specified matter(s) does not exceed the amount specified in Directions

- - -

223J(3)

Revenue administration resource use does not exceed the amount specified in Directions

3,720 3,190 Yes

Note: For the purposes of 223H(1); expenditure is defined as the aggregate of gross expenditure on revenue and capital in the financial year; and, income is defined as the aggregate of the notified maximum revenue resource, notified capital resource and all other amounts accounted as received in the financial year (whether under provisions of the Act or from other sources, and included here on a gross basis).

43. Impact of IFRS Accounting under IFRS had no impact on the results of the Clinical Commissioning Group during the 2013/14 financial year.

44. Analysis of charitable reserves

The Clinical Commissioning Group had no charitable reserves as at 31 March 2014. Dr David Hambleton Accountable Officer 4 June 2014

109

South Tyneside Executive Committee Minutes of Meeting held on Thursday 1st May 2014

9.00am to 12.00noon at Monkton Hall

Present: Christine Briggs, Director of Operations (Chairing) Ros Whitehead, Practice Management Lead

Ann Fox, Director of Nursing Quality and Safety Dr James Gordon, Clinical Director, Mental Health\Learning Disability Dr Matthew Walmsley, STCCG Chair Dr Funmi Nixon, Clinical Director, Long Term Conditions Joanne Moore, Commissioning & Quality Lead - LA Jenna Easton, Administrative Support

In attendance: Ailsa Nokes, Head of Customer Programme - NECS Janice Chandler, Commissioning Manager - LA Aaron Tucker, Commissioning Manager Apologies: Dr David Hambleton, Chief Officer

Gary Collier, Senior Commissioning Manager - Provider Management NECS Dr Jon Tose, Clinical Director, Planned Care Amanda Healy, Director of Public Health - LA

1. Welcome

Christine Briggs welcomed all to the meeting noting her chair position today in David’s absence.

2. Declarations of Interest No declarations of interest were expressed.

3. Minutes of meeting held on 10h April 2014 A number of changes were agreed for the minutes of the last meeting. The Committee agreed the minutes as an accurate record subject to the changes being made Action: Jenna to update minutes of meeting held on 10th April to retain as accurate record.

4. Matters Arising

• AQP

It was noted, following on from the March Executive meeting, that communication had been made with general practice regarding -procurement of AQP services.

• Acute Care Hub David Hambleton is leading a project group which has now been established. Membership has been finalised.

5. Chair’s Information

Strategic plan assurance review sessions had taken place on 15th May at NHS England’s offices at Newburn with all CCGs in the North East; STCCG had been invited to participate jointly with Sunderland CCG so will be delivering presentations on separate units of planning along, illustrating shared common ground work between the two CCG’s.


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6. Quality and Performance Report Quality Update Jenna agreed to circulate performance report to Executive Committee members for information. Ann outlined the highlights from within the quality report including key achievements and potential risks.

• Serious Incident reporting is becoming an upward trend of improvement with along with targets of reporting within 2 working days. A number of providers have addressed internal governance meetings and are developing initiatives to speed up the process of submitting reports to responsible commissioners. Representatives of NECS continue to meet regularly with CHSFT and STFT to ensure effective delivery of the SI process.

• Friends and Family results feedback - A request has been made at the CQRG for the Trust to include qualitative comments made by patients in future reports /feedback.

• Discussion ensued regarding care home provision in South Tyneside and associated risks when a home comes under scrutiny for quality issues. A current case was discussed around which members noted progress.

STFT CQRG is held bimonthly the last meeting was held in April 2014. Highlights of the Key Risks and Assurances are as follows:

• Family and Friends Test: the reduction in FFT response rate and score in A&E has been discussed. The Trust advised that key members of staff who champion the Test have been absent recently, and this will be addressed. The maternity results were not presented, as the Trust stated they were having difficulties capturing the data and this will be discussed at the next meeting. The Trust will introduce the staff FFT in June 2014.

• The latest TARN Report for March 2014: has been released and was shared after the meeting with the committee, this provided assurance that all the required actions had been completed and the Trust is fully compliant.

• The Choose Safer Care report: was presented and the CCG commended the report as providing key assurance, as it demonstrates continuous improvements in patient safety.

• SI and Never Event status report: There is a significant improvement in the percentage of SIs reported within the guidance of 2 working days with 59% in February 2014. It was requested that NECS look at the numbers that are reported in the region to benchmark what is a realistic percentage to be achievement.

• Sentinel Stroke Audit report: Assurance was given that the Trust has produced an action plan to their Board demonstrating a consistent improvement in this service area year on year.

• Quality v Cost Improvement Impact Exception and Assurance Report: STFT provided an extract from the Transformation Board unconfirmed minutes; the Trust confirmed that they were assured there was no significant clinical risk within the CIP/Transformation Programme presented.

• CQUIN 2013/14: Q3 position was presented and agreed. • Integrated Quality and Performance Report: Continuing Healthcare Care presents a major

quality risk for the CCG; which is significantly impacting upon overall performance figures. An RPIW has recently been carried out by the Trust reviewing the whole systems process and look forward to the opportunity to share outcomes.

• The Datix Incidents, Complaints and Litigation Report Q3 was presented and discussed.

Performance Update Aaron gave an update around the performance section within the joint report highlighting any risks and sensitive areas in Gary Collier’s absence and Kate gave an overall contractual update. The Committee noted the following points:

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South Tyneside Foundation Trust (STFT) Month 12 year-end position was noted to be over contracted level generally. However, significant underperformance against March contracted activity levels had resulted in a positive movement in the year end position for the CCG. Long Stay Patients activity has reduced in the latter months of the contract year which is also positive. Overall performance was under contract and finally at a position where CQUIN hasn’t been merged. City Hospitals Sunderland Foundation Trust (CHSFT) City Hospitals Sunderland continues to experience significant data difficulties following the implementation of the PAS system. A robust mechanism will be in place for next year. The contract has moved into a position of slight over performance. In order to ensure financial certainty, an agreement was reached in relation to the 2013/14 full year position with the CCG. A key risk is AQP audiology which needs to be kept on the radar. Newcastle and Gateshead High Cost Drugs remains the largest area of over performance within the contract and medical devices have also increased slightly presenting pressure. Need to acknowledge Gateshead could be a risk going forward. Acknowledged a deep dive activity needs to be picked up through COG meeting on Gateshead Issues. Overall, Newcastle Hospitals did not present the level of pressure anticipated as predicted.

NEAS Contract performance is over based on risk share of £172k none recurrent activity every year.

CCG Performance

• Performance against Cancer 2 week waiting time target of 93% continues above target at all FTs ytd but below target in February for GHFT.

• % of patients treated within 31 days of a cancer diagnosis below target at CHS in February. • Treatment within 62 days of urgent GP referral has fallen below target in February at CHS and

NUHT, although performance remains above the YTD target. • 62 day wait screening services at STFT has fallen from 25% in November to 20% in December

to February due to very small numbers. • City Hospitals Sunderland continues to experience pressure within the A&E Department,

impacting on their ability to deliver the 4 hour target. Performance at the end of March is at 94.4% compared to a target of 95%. However in January and February they have achieved the diagnostic waiting time target which they failed in December. South Tyneside NHSFT performance in A&E remains above target at 98.6% YTD at the end of March.

• Gateshead FT report 1 breach of 52 weeks. However this is not a STCCG patient and validation has identified it to be incorrect. Therefore this is not reported by South Tyneside CCG.

• 2 Incidents of MRSA have been reported in the CCG locality for the period up to the end of February, breaching the annual target of 0 and impacting on the CCG Quality Premium.

• C Diff targets have been exceeded by all providers.

7. Finance Report Kate gave an update to year-end position for STCCG. The CCG has not been able to deliver the planned 1% surplus for a number of reasons however has delivered a surplus of 0.2%, a slight improvement on the position reported at month 11. At this stage no definitive guidance has been received from NHS England regarding return of surplus in 2014/15. It was noted that for future financial plans include reaching a 1% surplus position over a 3 year period. Kate confirmed that an external audit is taking place over the next 2-3 weeks and accounts will be reviewed on 22nd May.

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8. Weight Management Pathway Mark Girvan was in attendance to update the Executive on NHS England and Public Health England consultation to the obesity care pathway. It was noted that national guidance recommends a 4 tier pathway for the management of obesity. Additionally, it recommends access to tier 4 is restricted to those patients who have previously undergone tier 3 interventions for a period of 12-24 months. Tier 3 services were historically commissioned by the PCT and moved to the Council as part of the Public Health transfer on 1st April 2103.Following a value for money review by the Council in 2013 the tier 3 service was decommissioned from April 2014. . An NHS England and Public Health England working group has published an options appraisal around the future commissioning arrangements for all 4 tiers of provision. It recommends tiers 1-2 are commissioned via public health, tier 3 by CCGs and tier 4 by specialist commissioning. This recommendation is currently out for consultation with responses due by 6th May. Discussion ensued, and James Gordon asked the percentage of IAPT input into Tier 3; Janice Chandler agreed to gather information and send onto James. Action: Janice Chandler to send information The Committee formed the view that it did not make sense to fragment the pathway further and wished to respond to the consultation in this vein. A further consideration would be that, as the funding transferred to the Council from the CCG, the CCG does not have the funding available to commission a T3 service. From a local perspective, Mark confirmed a meeting is in place between STFT, CCG and LA colleagues although the requirement for early commissioner discussions was noted. Mark asked for any further comments around the proposals to be sent to him before the deadline of 6th May.

9. Policies for ratification – other annual leave policy Christine briefly presented the policy which sets out staff leave options available, which has been created by colleagues in NECS on the CCG’s behalf. It was recognised that special leave for gender re-assignment needs to be added to the policy and NECS colleagues agreed to carry out this update Ailsa also clarified that a front cover sheet needs adding to each policy created to confirm its position and whether if it has been rolled over from an existing policy. Action: Ailsa to oversee updating policy and its resubmission.

10. Equality Objectives progress report Gillian Stanger was in attendance to update on progress with equality objectives action plan which was agreed in February 2014. An idea was expressed for a sound enabling tool to be available with every document published onto our website along with “you-tube” style videos if required. It was agreed that the CCG should be using different types of media to get key messages across will be explored. The percentages of staff statutory mandatory training results within the report were noted to be incorrect and needed to be explored as some technical issues have arisen with recording figures. Action: Gillian Stanger to provide CCG with accurate figures.

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11. Delivery Plan Aaron gave a verbal update around STCCG’s delivery plan and ongoing progress with the 5 year plan. Trajectories for the 2 year plans have now been submitted and will be shared and discussed with council of practice members along with 5 year plan on Thursday 15th May. 5 year trajectories are currently being deliberated post feedback from the Area Team around levels of ambition A refreshed new style plan on a page has been designed and is currently being tested with stakeholders. . The Executive highlighted their satisfaction with progress made. . Aaron shared confirmed that key deliverables and milestones within the delivery plan for this year are being mapped out and will be shared with colleagues once finalised.

12. Mental Health Consultation Update Caroline Latta was in attendance to summarise the consultation process relating to patient services and highlight commissioning recommendations following the consultation. She illustrated that matters relating to travel arrangements and the involvement of carer’s in crisis issues fell out as key concerns from the consultation process. It was agreed to discuss these routinely at monthly joint CCG / NTW Contract Review Meetings with Jim advising that he would be picking up all relevant issues with NTW with a view to establishing a mutually agreeable way forward, prior to changes occurring. Ann agreed to factor the Mental Health consultation into a future QRG meeting, with Rebecca Eadie and James Gordon being involved with deliberations. Caroline asked the Executive to reflect on the consultation document to get a broad idea of whole proposal. The Executive agreed that, subject to the resolution of issues identified during consultation, testing of community pathways could start however final sign off from STCCG could not occur until the July Governing Body meeting. ACTION: To inform Laura Witters to add to July Governing Body agenda. Caroline Latta agreed to liaise with key individuals on a one to one basis to tweak the consultation report where needed to get it to a finalised stage.

13. Integration Board Update Christine shared the report which described the role of the South Tyneside Integration Board and illustrated progress. In relation to the Better Care Fund, a plan had been submitted to NHS England within required timeframes, with four key work streams being pivotal to the achievement of the integration agenda in the borough. It was agreed an additional work stream to add to list is mapping national conditions against the BCF. Christine confirmed all integration board minutes are circulated to the Committee for information on a fortnightly basis via Jane Leighton. All Better Care Fund trajectories and finalised narratives were noted to have been submitted by the 4th April deadline Transformation work streams linked to integration work are discussed at each Integration Board meeting to ensure all parties are aware of progress and to hold one another to account around progress

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Quarterly reports would be provided to the Executive Committee around the Integration Board, unless anything urgent needed. Jenna to add to forward planner. Action: Jenna to add to forward planner.

14. Public Health Update Janice Chandler confirmed that an in depth sexual health and NHS health checks update will be given at the June Executive Committee meeting. A domestic violence review has also been initiated, further information will follow at an appropriate point. The impact and implications of Northern Rock Foundation closure and associated cessation of third sector funding were discussed, with concerns being expressed around the potential impact of this. Ailsa agreed to explore whether there was any knowledge around this matter at NECS in terms of overall impact.

15. AOB Perth Green intermediate procurement and evaluation strategy - Matthew Walmsley agreed to take a lead clinical role in this and be included in ongoing work outside of Executive Committee meetings, given that he would exclude himself and his practice from the bid process and thus could take part without any conflict of interest. The Executive Committee approved this approach on the basis outlined.

16. Date and Time of next meeting: 12th June 2014, 9.00 – 12.00noon at Monkton Hall, Meeting Room 1

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South Tyneside Executive Committee

Minutes of Meeting held on Thursday 12th June 2014 10.30am to 1.30pm at Monkton Hall

Present: Dr David Hambleton, Chief Officer (Chairing Meeting) Christine Briggs, Director of Operations

Dr Funmi Nixon, Clinical Director Ros Whitehead, Practice Management Lead

Amanda Healy, Director of Public Health Ann Fox, Director of Nursing Quality and Safety Kate Hudson, Chief Finance Officer Dr Jon Tose, Clinical Director Jenna Easton, Administrative Support

In attendance: Gary Collier, Senior Commissioning Manager - Provider Management NECS Aaron Tucker, Commissioning Manager STCCG Christine Shields, ST Council, Strategic Commissioning Manager

Ailsa Nokes, Head of Customer Programme, NECS Jo Farey, Commissioning Manager STCCG Sarah Graham, Senior Governance Officer, NECS Shona Haining, Senior Manager Research & Development, NECS Michael Wise, Procurement Officer, NECS

Apologies: Joanne Moore, ST Council, Commissioning & Quality Lead

Dr James Gordon, Clinical Director Dr Matthew Walmsley, STCCG Chair

1. Welcome David welcomed all and thanked everyone for accommodating a later start to the meeting.

2. Declarations of Interest Declarations of interest were expressed for items 10. Primary Care Scheme and potential for sexual health review for Jon Tose, Funmi Nixon and Ros Whitehead.

3. Minutes of meeting held on 1st May 2014 Minutes were changed to support accuracy as follows: STFT reported position did not reflect what was discussed in regards to being under contract at end of year position with acute contract. CQUIN is not incorporated into any year end agreement. To be clear CQUIN and activity are kept separate.

4. Matters Arising

• IAPT – James still to receive percentage of IAPT input into Tier 3 from Janice Chandler. Amanda agreed to pick up.

• The percentages of staff statutory mandatory training results are still to be confirmed by Gillian Stanger.

5. Chair’s Information

David confirmed our Q4 assurance meeting took place with the area team with a positive outcome in terms of year-end review. John Lawlor was positive around STCCG achievements and commented on effective partnerships which have been formed. A lot of praise was received for STCCG.


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Quarterly board to board meeting with STFT was again very positive with an outcome of agreement to look at how to incorporate our 5 year plan in detailed conversations with all partners. The launch of South Tyneside urgent care hub consultation is now being discussed publicly. A number of meetings are due to take place. Due to the publicity involved and this being very sensitive David asked for the committee to be aware of a potentially rocky road ahead for STCCG. David agreed to meet with a representative from National Audit Office around value for money study on public health system. Amanda to forward contact details for Jane to arrange. STCCG members attended Hebburn Lakes primary school to work with students around future working prospects and sharing job experiences to prepare them for working life. The Head teacher confirmed there was great interaction with kids and asked if future visits can take place again next year due to the positive impact.

6. Quality and Performance Report South Tyneside Foundation Trust (STFT) Reporting on month 1 position has resulted in overall contract underperformance. Gary confirmed the report includes comparisons to last year in trends and activity. In relation to other services, Long Stay Patients activity has reduced significantly in comparison to the levels seen in 2013/14. Month 1 includes charges for 60 bed days, equivalent to two patients in beds for the month. NEAS position reporting is break-even with an increased activity in comparison to contract and 2013/14 levels. City Hospitals Sunderland Foundation Trust (CHSFT) Month 1 figures are slight under performance with still ongoing data issues. Gateshead FT A big reconciliation process is ongoing. The focus remains on improving data quality through reconciliation with NECS SUS data with detailed activity plans in place by June 2014. Once completed will allow to move to full PBR type contract. This will result in a block contract for April if not met by June. CHC in relation to 28 day targets are green across the board. Changes in counting to make sure providers are in line to our counting guidelines. An event is taking place on 30th June to map the full pathway with Jackie Welsh leading. Internal conversations are taken place to understand the quality performance aspect. Ann agreed to attend and for Chris McEwan to be invited. CCG performance – majority of data is still year-end due to timing and publication.

• RTT yea-rend performance has been good and does not present us a problem, however it was mentioned as the targets are coming under more scrutiny nationally and therefore will have more focus in performance reports.

• A&E targets have been achieved for South Tyneside. • Cancer Route Cause Analysis (RCA) review is underway, with more detail requested on the capacity

breaches. Report will be taken to the COG and the cancer locality group. • Cancer - 2 week wait for breast, target breached in March with 5 breaches due to patient choice. At

year-end this target is achieved • Cancer - 62 days from NHS screening service, target breached at year-end, as previously discussed

at exec, this has been a problem for several months, it is due to small numbers being seen in the pathway, which means one patient breaching has a significant effect on the target.

• Emergency admissions for Asthma Diabetes and Epilepsy the CCG has failed this target at year-end – Analysis of this targets performance is to be shared at the COG.

• Patient experience of GPs – new data on the score card, that needs investigation for its impact on the trajectories set for 2014/15.

• IAPT – the CCG has failed at year end access target by 0.2%. Indications from the provider are that for month 1 they are achieving the trajectory for 2014/15.

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Jon asked for a stand up to be carried out on detailed CCG indicators for quality. Safeguarding Update Ann outlined the highlights from within the safeguarding report including key achievements and potential risks.

• At the recent CQC visit reported in April 2014 NEAS failed 4 out of the six standards, including one relating to the lack of Disclosure & Barring Service (DBS) checks, where enforcement action has already been taken. Action is required on:

1. Management of medicines 2. Requirements relating to workers 3. Supporting Workers 4. Assessing and monitoring the quality of service provision.

Ann confirmed the Trust’s action plan will be submitted to the Quality Review Group. • Mortality – ongoing theme, discussed at every quality review group. Independent review undertaken

at STFT, assurance if St Benedict’s figures removed will be within expected range however it is not possible for this to be undertaken nationally. City Hospitals also had similar issues, special QRG to take place rather than a risk summit in August. Case note review being implemented at City Hospitals Sunderland – this will also be reviewed at the QRG.

• Improvements have been shown with Friends and Family Tests. • SI reporting has shown improvements within the 2-day reporting period. The providers have

addressed this by setting internal governance meetings and are developing initiatives to speed up the process of submitting reports to responsible commissioners. Assurance has been given by STFT with regards to reporting of open and honest care metrics. Reporting safer staffing will be published nationally for the first time in June. Communication leads are aligned around key messages. FT‘s have produced staffing papers.

• Safeguarding issues are ongoing; the Meadows Care Home has improved however Stapleton House has now raised alerts. Both care homes being Four Seasons providers. Quality concerns in care homes owned by Four Seasons have been reported to the CNTW QSG. It was acknowledged a big concern for STCCG as there is no linked GP assigned to these care homes however ongoing work is being undertaken to resolve this problem.

7. Finance Update

Kate gave a verbal briefing on the current financial position. STCCG have a break even position currently at month 1 reporting. Quality premium wasn’t covered within the performance report with an anticipated £650k for quality premium payment. Kate confirmed it is looking likely STCCG will not receive this due to not achieving financial surplus target. Plans are in place to contest this decision.A letter has been drafted to area team; however it was acknowledged a collective letter across North East region would have more of an impact.

8. Minor Ailments Item deferred to July Executive meeting.

9. Primary Care Scheme Jo Farey was in attendance to give an update from the last position which was reported at April’s Executive Committee. Executive Members are asked to endorse the finalised scheme and the use of the £2.05 per patient for the payment to practices to participate in the scheme in 2014/15. This will equate to about £0.46 per patient for each of the 4 clinical work streams. Performance monitoring and reporting will be considered in relation to appropriate scaling of financial reward if some or part of each indicator is not achieved by practices. Given that this scheme will not commence until 1st July 2014, it is proposed that the scheme run in its current planned state from 1st July 2014 until at least 30th June 2015, using a proportion of 15/16 funding for Q1 of 15/16.

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It was acknowledged exhaustive communication needs to be sent to practices around how the CCG measure this project. As assurance needs built in it was proposed for verified random practice checks to take place along with training, support and development plans to support practices. Jo confirmed the scheme was presented to the LMC who have given approval and are on-board with the proposal.The Executive agreed to endorse the proposal of running with the current state from 1st July 2014 until 30th June 2015. Kate highlighted the fact that the scheme is funded from non-recurrent pot which will be reduced next year.

10. CHC Retrospective Update STCCG is working with Gateshead and Sunderland CCGs, having commissioned STFT to process and consider claims. Christine confirmed all CHC retrospective claims aren’t always relating to patients in care homes, CHC applies where an adult individual’s care needs are predominately driven by a health need. To make it more complicated the CHC process keeps changing. A lot of changes to case numbers previously reported. Due to confusions around case numbers a significant review took place to identify cases relating to South Tyneside. A significant number of cases are currently on hold. Retrospective CHC carries risk for CCGs from a financial and reputational perspective. Legal advice is being anticipated, not as straight forward as predicted.

11. Q4 figures for FOI/ SAR and R&D Sarah Graham was in attendance to Report on the number of Freedom of Information and Subject requests received by NECS on behalf of South Tyneside CCG. A selected of different key themes to date were reported which Sarah highlighted all cases are responded within a 20 day deadline and all FOI requests received were acknowledged within 48 hours in line with the Information Commissioner’s Office (ICO) requirements. Shona Haining was also in attendance to present on Research and Development and thanked South Tyneside colleagues who were involved with preparing reports. South Tyneside are achieving in every quarter to date. There is currently 5 practices research active, with a lot of work ongoing to promote and prompt more practices to be involved. Discussion took place with NECS agreeing to support STCCG strategy around R&D going forward. Shona agreed to share activity data in all clinical areas for each locality. Ann agreed to feed into QRG meetings to share reports and dialog for information. The Committee thanked both Sarah and Shona for attending.

12. 360 degree stakeholder survey Christine updated on 360 degree stakeholder survey which the main purpose was to enable stakeholders to provide feedback on working relationships with STCCG. The results of the survey will provide data for STCCG to help with ongoing organisational development and enable us to continue to build strong and productive relationships with stakeholders. Of the 53 stakeholders invited to take part 43 completed the survey, a response rate of 81%. Results show very positive report overall, painting a positive picture of STCCG. Answers were compared with responses that were received in 2012. 63% revealed STCCG were doing better than the average. It was recognised an opportunity at September’s development session will allow planning on future progress and concepts. Christine confirmed the survey has been circulated for information.

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13. Draft 5 year plan Item postponed.

14. Approval of recommended bidder report for the non-urgent patient transport booking service procurement

Michael Wise, NECS procurement officer was in attendance to advise the Executive Committee of the outcome of the tender evaluations for the Non-Urgent Patient Transport Booking Service for South Tyneside CCG and to seek approval from the report in respect of the non-urgent patient transport booking services. Bidder 2 is approved as a Recommended Bidder for the Non-Urgent Patient Transport Booking Service, as their submission was the most economically advantageous tender received. The contract value of the winning bidder’s submission is £160,197 over a maximum duration of three years. Michael confirmed the procurement is linked to Gateshead CCG which they have approved bidder 2 on 1st June. STCCG agreed they were comfortable with all arrangements and also approved with bidder 2.

15. Sexual Health Review Janice Chandler attended to inform on latest position with South Tyneside sexual health review services which haven’t been reviewed for a long period. Commissioning arrangements have become complicated due to split of commissioning services with CCG and LA. The main themes being value for money, effectiveness and current mapping against clinical guidance is essential. A few different methods of gathering information has been carried out; health needs assessments, audit with GP’s and pharmacies around service provision, focus groups to target different audiences, survey monkey’s and individual questionnaires. It was agreed for Termination of pregnancy services to be included within the review. Clinical input from STCCG to be discussed in house. STCCG colleagues agreed to decide who would be best suited to link and provide support.

16. Domestic Violence Review

Local Authority Public Health is currently undertaking a review of domestic violence provision to address the key issues of commissioning, funding and co-ordination between services and the lack of early intervention and preventative work. It was acknowledged domestic violence is historically underfunded and very complex. A main problem being everyone accepts how much of an issue domestic violence is however no plans are in place for prevention resulting in a review being carried out to ease current pressures. A workshop took place with different providers in attendance which was very effective with different understandings gained. An outcome revealed this is a very challenging area to work in with no additional funding and understaffing being an issue. The Executive agreed to have a CCG link into domestic violence review. Ann confirmed there are already solid established links in place with STCCG safeguarding team.

17. Smoking during pregnancy Wendy Surtees was in attendance to share with the Executive progress to date smoking in pregnancy pathway. 28.9% of women resident in South Tyneside who gave birth during the third quarter of 2013/14 were smoking at the time of giving birth this being a higher proportion than in any other local authority in the country. It is

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significantly higher than any neighbouring authority, and significantly higher than the North of England average. Partly in light of the poor figures, the ‘Smoking in Pregnancy Pathway’ for South Tyneside was re-launched in May 2013. The effect of this change will not start to be seen until Quarter 4 2013/14 data is released next month therefore any decisions made around altering the pathway are on hold. South Tyneside has recently employed a smoking maternity midwife which is the first in the region along with being included in roll out of baby clear programme. It was noted STFT may play a role in relation to CQUIN indicator for smoking. It was agreed for public health need to be part of all CQUIN discussions.

18. Executive Committee front cover template There were issues raised in relation to Executive Committee front cover template. Jon asked for additional box to be added which will give a robust evaluation of report to encourage authors of papers to formalise evidence of reports for Executive which is needed. However it was noted governance guidance refers for all committees to use the same standard template across the board. The Executive agreed to use Governance corporate template and modify this to suit executive committee needs. It was agreed to add another box to support evidence and for completion of equality impact assessment section. ACTION: Jenna to tweak front cover template to reflect what was discussed. It was also agreed for each lead sponsor to view and approve reports before adding their signature as sign off before appearing at each Executive Committee.

19. Date and time of next meeting: 3rd July 2014, 9.30 – 12.00noon at Monkton Hall, Meeting room 1

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Thursday 20 March 2014 15:00 – 16:00

Chuter Ede Education Centre, Galsworthy Road, South Shields, NE34 9UG

Present: Lead GPs As per attendance list (attached) Practice Managers As per attendance list (attached) Dr Matthew Walmsley Chair, South Tyneside Clinical Commissioning

Group (STCCG) Dr David Hambleton Chief Officer, STCCG 2014/01 Welcome and Introductions

The Chair welcomed everyone to the Council of Practices.

There were no matters arising from the previous minutes: the minutes were checked for accuracy and agreed as a true record.

2014/02 Commissioning Intentions

The Chair began with a presentation around a Case for Change and a set of plans for South Tyneside for the next five years. • Potential funding gap of £30bn by 2020/21 • Health inequalities and life expectancy gap /shorter lives • High numbers of non-elective admissions for ACS conditions • We need to look at ways of change • Engagement • Develop South Tyneside 5 Year Plan as a whole/work program 2-5

years for Cancer, CVD and Respiratory

Key work areas need to be concentrated around: • Urgent Care Hub • Integration of Community teams • Pioneer status • End of Life Care scheme • Pulmonary and Cardiac Rehabilitation • Child and Adolescent Mental Health Service (CAMHS) Tier 2

The draft 5 Year Plan was highlighted by Matthew and he talked of the vision for South Tyneside health and social care partnership and where we will be in 2018/19. The draft 5 Year Plan also held information on

Accepted: 19 June 2014

delivery and outcome ambitions. A copy of the Plan on a Page was circulated to the members attending today.

NHS England have published their Strategic & Operational Planning for 2014/19 and this can be found on line and include: • Strategic plans covering a five year period, with first two years at

operating plan level • An outcomes focused approach, with stretching local ambitions

expected of commissioners, alongside credible and costed plans to deliver them

• Citizen inclusion and empowerment to focus on what patients want and need

• More integration between providers and commissioners • More integration with social care – cooperation with Local

Authorities on better care fund planning • Plans to be explicit in dealing with the financial gap and risk and

mitigation strategies. No change not an option

We need to make the right changes locally and commission resources appropriately.

In between the dates of the Work Program will be a General Election and the issue of funding will be raised. Next year will be key and then there will the need to be streamlining in the right places – especially around the Urgent Care Hub.

The Jarrow Walk in centre was discussed and the integrated commissioning teams. There is a small number of GPs taking part in how we progress this work. There are a lot of people behind the scenes to ensure that it works for everybody.

The Chair highlighted that Nationally Regulated Integrated Pioneer Programme into self-care solutions for South Tyneside across organisations to promote patients to also help themselves and have more input into their care. The acceptance of this solution is growing slowly but will take further culture change across the borough.

2014/03 Services to support GP accountability for the over 75s

The Chief Officer introduced this item with a presentation and highlighted the commissioning of Primary Care with emphasis on: • An accountable GP for over 75s • Enhanced service to reduce avoidable admissions • GP incentive scheme

Working locally CCGs need to have more of a role in Primary Care Commissioning.

Accepted: 19 June 2014 Page 2 of 6

The funding of the accountable GP for over 75s will be at approximately £5/head of the population for each practice. Practice plans should be complementary to initiatives through the Better Care Fund.

The Chief Officer highlighted that we have been awaiting more detail but this has not happened yet. We expect that CCGs will need to be innovative as to how the money is spent.

The view of the BMA was discussed as they do not expect there will be significant additional burden to the work of GPs or their practice staff. Work should be in line with the arrangements already in place in many practices. David highlighted comments by Dr Ken Megson, Medical Secretary of Gateshead and South Tyneside LMC and his prediction that CCGs would struggle to find the funding. “There is no new money available. What CCGs will do is take money out of secondary care and slosh it into primary care. It’s not about giving GPs a head to do things differently, but giving services such as district nursing some money to keep people in the community”.

An enhanced service is required to avoid admissions and proactive patient management is required. Reduction in QOF is needed to allow GP practices greater opportunity to understand the needs of the patients who most need their support to stay well in the community and avoid unplanned hospital admissions. The approach needs to be a real partnership between CCGs and GP Practices. There needs to be individual care plans and also in the Care Home Scheme with the potential to overlap services perhaps. It makes sense in the overlapping with other areas.

The Chief Officer carried on and highlighted the GP Incentive Scheme for 2014/15. This may overlap into the new financial year: • STICs to continue for Q1 (patient reviews after admissions or A&E

attendance only) • Remainder of scheme focussing on:

o End of Life Care o Cancer o CVD o Respiratory

The themes within the scheme: • Early diagnosis and screening • Patient experience • Education of professionals • Management of the patient and self-care • Integration and access to wider primary care • Managing variability within primary care


The Chief Officer asked members of the Council “what do you think we should put into this?” We must ensure we achieve value for money.

The Chief Officer ended his presentation at 3:30pm and the Chair thanked him for sharing the presentation and information with the Council.

The Chair introduced a question and answer session for the 30 minutes remaining and posed the following questions: • Are we going in the right direction/on track with our 5 year plan? • How do we want to be involved in primary care decisions? • £.75m for care of the over 75s – what are your thoughts? • Incentive scheme – what are your comments?

We want your ideas.

Questions raised from members of the Council: Q – Around Urgent Care and what investment will there be in premises? • FT Premises will need to do this £wise – but it would not be a

massive cost • Jarrow Walk in Centre may be closed but that decision had not

been made yet

Q – If the accountable GP is a named individual there needs to be co-ordination for each patient – how does the innovation program map into the concept in the first place? Will it create more work? • There would be more work around services we could invest in • Once you have named someone this creates commissioning issues • These are National suggestions and it will be difficult to sign this off

Q – Will higher levels of information from patients create more work? Q - How do you manage this work? • IT solutions put in place could be an option

If you have any other ideas as to how to spend £5/head – then let’s have your ideas

Q – How will CCGs separate this out from strategic issues? How will they balance this? • We are now being given the responsibility – we need to discuss

further how we manage this – but we must • There is an element of inevitability about this • A solution needs to be achieved quickly

Q – Around the accountable GP and who decides? • The practice will decide and could inform the patient either by:

o Mail shot o Or at next appointment


Q – The £5 funding – will it go to the CCG or the practice? • The £5 will come from the CCG budget • The practice will have to discuss how we spend it

Q – around enhanced services – Practices will be given their allocation and concern is raised around the CCG telling practices what we spend it on? • Infections/Warfarin • CCGs to make decisions on all services and agree with practices

Q – Comment received around the expectations of patients – patients ring into the Practice and have their own choice of which GP to see – might this not make more work? • The Chief Officer highlighted the BMA website and the detailed

guidance

Q – Comment that it will probably cost more than the £5 per patient – it may not be enough and people are being asked to manage another responsibility and putting money into innovation – practices are burning out through over work. • We need conversations as to how GP practices will manage patient

expectations • Costs will not be in pure administration costs only but also in

enhanced services out of this £5 pot • Could spend towards improved IT to save work • Or in innovation across the borough • There could be increased spending year on year but this is not

agreed yet

Q – The BMA advised that it will not create too much extra work but will we be losing other enhanced services? The service at present is not too well joined up – how do we make the service better? How to make it more integrated than it is now? The BMA advised that there will not be too much extra work but why give £5 from CCG pot per head. The burdon will be on Practices with more elderly patients – how do we get value for money?

• The Chief Officer asked the Council how many members of the

Council here today thought that the £5/head would go directly into Practices?

Most members raised their hands to agree – about a 2/3 majority - and 1/3 said No.

• The Chief Officer highlighted the BMA and LMC comments and the

fact that we need to find a way forward to see if the spending of cash for the over 75s was do-able

• We need to look at how others spend this money


• Some CCGs are just spending into community services • This is a problem for us all – we have to manage this

Q – Is this workable? • There was no show of hands • Most of this is workable anyway as most patients nominate a GP

when making an appointment

Q - Comment - yes but for the £5 this will create more work? • But this is working now

Q – Comment raised about legal questions and patients naming their GP when things go wrong – what about Quality Assurance? Q – Comment – there could be trouble when a patient can’t see their named GP Q – Comment highlighted about costs of IT projects • The Chief Officer highlighted that we need to share our thoughts as

to how we can achieve a better service for the over 75s • What are other local CCGs considering? • We may be the first with these questions • CCGs in other parts of the country are spending on community

services

Q – the question of time lines was considered • 1st April – but this might not happen

Q – A structure of additional services – social work needs to work together • We need to continue getting community resources into GP

Practices

Action: The Chief Officer agreed to send out proposals – by 4 April 2014

The Chair thanked everyone for their attendance today and concluded the meeting of the Council at 4pm.


The next meeting of the Council of Practices will be held on Thursday 19 June 2014, 15:00 – 16:00, at Chuter Ede Education Centre, Galsworthy Road, South Shields, NE34 9UG.




19 June 2014 15:00 – 16:00

Chuter Ede Education Centre, Galsworthy Road, South Shields NE34 9UG

Present: Lead GPs As per attendance sheet (attached) Practice Managers As per attendance sheet (attached) Dr David Hambleton Chief Officer, South Tyneside Clinical Commissioning

Group (STCCG) Dr Jon Tose Clinical Director, STCCG Dr Jim Gordon Clinical Director, STCCG Apologies: Dr Matthew Walmsley Chair, STCCG 2014/05 Welcome and introductions

The Chair welcomed those present to the Council of Practices meeting. 2014/06 Updates

End of Year Assurance

Dr Hambleton reported that the Quarter 4 Assurance meeting had been positive – the Area Team was enthusiastic and very impressed with how well we have done. We have hit our financial targets and we are leading the South Tyneside health economy in a very positive way. DH thanked all of the member practices for their contribution over the last year.

Co-commissioning of Primary Care

The newly appointed Chief Executive of NHS England was asking CCGs to consider commission more services, including GP services. We feel our relationship with our member practices is good. We are keen to move on with developing primary care. We need to develop our primary care strategy and investigate how we improve on quality of primary care. It may be beneficial to look at Enhanced services more holistically as these are currently very fragmented.

Other than those areas, Dr Hambleton highlighted that South Tyneside would not be expressing an interest in commissioning services more widely from primary care. It was agreed not to get involved in commissioning more services from primary care and that a reply would be sent to Simon Stevens tomorrow.

The question was asked if some other organisation would take it on. No – as commissioning these services would still lie with the Area Team.

Stakeholder Feedback

Dr Hambleton highlighted that results had been received from the latest stakeholder survey and were very positive. The broad group of people was talking appropriately as a whole.

The survey will be circulated.

2014/07 Services to support GPs accountable for over 75’s

Survey results from practices for use of £5/head funding:

1. Enhancing older peoples community mental health services – Score: 76

2. Supporting the integration of community teams – Score: 67 3. Support for self-care and social prescribing – Score: 65 4. Increasing urgent/non-bookable appointments – Score: 65

Suggested next steps

1. Small amount of money given to practices recognising change to

ways of working for personalised care 2. Commit to enhancing OPCMHT 3. Support initiatives coming out of Integrated Community Teams

workshops (6 this year) 4. Extra capacity to support primary care – approach STC Federation 5. Social prescribing – need to firm up ideas 6. Volunteers to join group to work these up

What will an integrated service look like?

Dr Hambleton confirmed that the CCG would be committed to the outcomes of the workshops – open invites will be sent out, plus targeted invites to individuals who express an interest.

Dr Hambleton asked for volunteers to work through any suggestions received today.

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Discussion took place as to the validity of using a questionnaire to obtain views from practices. It was recognised that here is no perfect way of doing this engagement, but that his had been the agreed way forward from the previous meeting. Some CCGs are advanced further with their plans than South Tyneside although others have fewer plans in place. Gateshead was highlighted as giving money directly to CBC although Gateshead may be an outlier not South Tyneside.

The CCG responded to a question that the CCG is not aware yet as to how much money will go directly to practices.

Dr Jim Gordon – asked what would be most helpful with this part of commissioning. STCCG is looking at further help to support patients with dementia; enhancing teams; additional support to carers and improving response times. How to spend the money better– the CCG is open to suggestions – e.g. therapy can be delivered by telephone for some patients with mental health problems and to older people.

Dr Jon Tose – highlighted the awareness of the pressures on GPs and nurses. Jon highlighted the GP Career Start Scheme; this may help in increase the number of patients seen and investigating longer appointments. We need to address that more and more care is in the patient’s home resulting in additional work for primary care.

A question around a timetable was posed as we need to start to demonstrate actions as soon as possible. The integration workshops will have produced plans to put forward by September 2014. We will know how we will be spending the £5/head by the end of the year.

There were no other comments from Council members.

Volunteers from the Council were sought as the CCG require a group to talk about the £5/head and any viable schemes. Or do we talk to the Federation re Primary Care – the CCG would welcome the views of Council members. The CCG was aware that not all practices are members of the Federation. There was a YES vote for the Federation to be present at group discussions. The time commitment to form a discussion group would probably involve two or three meetings/afternoons and then we should be able to report on findings and progress. One volunteer from each locality would be a good level of commitment.

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2014/08 Annual Report and Accounts

An audit report had been mandated to NHSE. The CCG had posted a financial surplus of 0.25% of overall budgets. We will need to post a 1% surplus by Year 3.

The news was therefore good on our financial position.

2014/09 Future Venues

A move to an alternative venue for future meetings of the Council of Practices was discussed with Dr Jon Tose.

A more contemporary venue would raise costs. The option of Cleadon Park was thought to be too small. As this is a very good location it was suggested that we stay with Chuter Ede and investigate better IT solutions.

A show of hands indicated that the consensus was to continue with Chuter Ede as a venue for future Council of Practices meetings.

Dr Hambleton thanked everyone for their attendance today and concluded the meeting at 4pm.


The next meeting of the Council of Practices will be held on Thursday 18 September 2014, 15:00 – 16:00, at Chuter Ede Education Centre, Galsworthy Road, South Shields, NE34 9UG. This meeting will include the AGM.

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Documents

Governing Body 10:00 – 12:00 Bede’s World, Church …...2015/02/17 · Welcome and introductions 2014/056 Apologies for absence Dr Matthew Walmsley 2014/057 Declarations of interest